Incidence rates of clinically significant tinnitus: 10-year trend from a cohort study in England

Abstract

Objective: To investigate the incidence of tinnitus that burdens the health service in England.

Design: This was an observational study of 4.7 million residents of England under 85 years of age who were at risk for developing clinically significant tinnitus (sigT). SigT was defined by a discharge from hospital with a primary diagnosis of tinnitus, or a primary care recording of tinnitus with subsequent related medical follow-up within 28 days. The database used was the Clinical Practice Research Datalink and individual records were linked to additional data from the Hospital Episode Statistics. The observational period was from January 1, 2002 to December 31, 2011. Age-, gender-, and calendar year-specific incidence rates for and cumulative incidences of sigT were estimated and a projection of new cases of sigT between 2012 and 2021 was performed.

Results: There were 14,303 incident cases of sigT identified among 26.5 million person-years of observation. The incidence rate was 5.4 new cases of sigT per 10,000 person-years (95% confidence interval: 5.3 to 5.5). The incidence rate did not depend on gender but increased with age, peaking at 11.4 per 10,000 in the age group 60 to 69 years. The annual incidence rate of sigT increased from 4.5 per 10,000 person-years in 2002 to 6.6 per 10,000 person-years in 2011. The 10-year cumulative incidence of sigT was 58.4 cases (95% confidence interval: 57.4 to 59.4) per 10,000 residents. Nearly 324,000 new cases of sigT are expected to occur in England between 2012 and 2021.

Conclusions: Tinnitus presents a burden to the health care system that has been rising in recent years. Population-based studies provide crucial underpinning evidence; highlighting the need for further research to address issues around effective diagnosis and clinical management of this heterogeneous condition.

Fig. 1.

Algorithm for detection of clinically significant tinnitus (sigT). Superscript numbers denote: Comprises a diagnosis for tinnitus, see Supplemental Digital Content 1 (http://links.lww.com/EANDH/A172) for specific code set. Comprises a diagnosis or procedure on the external, middle or inner ear or acoustic nerve, including hearing loss, Ménière’s disease, vestibular disorders, procedures to treat otosclerosis, and fitting of a hearing aid or implantation of a hearing device, see Supplemental Digital Contents 2, 3, and 4 (http://links.lww.com/EANDH/A172) for specific code sets. Consists of referrals to other specialist (otorhinolaryngology, neurology, radiology, psychiatry, psychology or counseling) with a specific referral reason including a hearing test, hearing-related problems, tinnitus, a diagnosis involving otosclerosis, Ménière’s disease, other vestibular disorders or a related procedure on the external, middle or inner ear or acoustic nerve, see Supplemental Digital Content 5 (http://links.lww.com/EANDH/A172) for specific code sets.

Fig. 2.

Ascertainment of patients with incident clinically significant tinnitus (sigT). ENT, ear, nose, and throat; Superscript numbers denote: Consists of referrals to other specialist (otorhinolaryngology, neurology, radiology, psychiatry, psychology, or counseling) with a specific referral reason including a hearing test, hearing-related problems, tinnitus, a diagnosis involving otosclerosis, Ménière’s disease, other vestibular disorders or a related procedure on the external, middle or inner ear or acoustic nerve, see Supplemental Digital Content 5 (http://links.lww.com/EANDH/A172) for specific code sets. Consists of referrals to audiologist, hearing aid clinic, or hearing therapist. Comprises a diagnosis or procedure on the external, middle or inner ear or acoustic nerve, including hearing loss, Ménière’s disease, vestibular disorders, procedures to treat otosclerosis, and fitting of a hearing aid or implantation of a hearing device, see Supplemental Digital Content 2, 3, and 4 (http://links.lww.com/EANDH/A172) for specific code sets.

Fig. 3.

Gender- and age-specific incidence rates of clinically significant tinnitus (sigT).

Fig. 4.

Incidence rates of clinically significant tinnitus (sigT) by calendar year with confidence intervals (CI) and fitted linear trend.