Global Prevalence and Incidence of Tinnitus: A Systematic Review and Meta-analysis

Abstract

Importance: To date, no systematic review has taken a meta-analytic approach to estimating the prevalence and incidence of tinnitus in the general population.

Objective: To provide frequency estimates of tinnitus worldwide.

Data sources: An umbrella review followed by a traditional systematic review was performed by searching PubMed-MEDLINE and Embase from inception through November 19, 2021.

Study selection: Research data from the general population were selected, and studies based on patients or on subgroups of the population with selected lifestyle habits were excluded. No restrictions were applied according to date, age, sex, and country.

Data extraction and synthesis: Relevant extracted information included type of study, time and location, end point, population characteristics, and tinnitus definition. The study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.

Main outcomes and measures: Pooled prevalence estimates of any tinnitus, severe tinnitus, chronic tinnitus, and diagnosed tinnitus as well as incidence of tinnitus were obtained using random-effects meta-analytic models; heterogeneity between studies was controlled using the χ2 test, and inconsistency was measured using the I2 statistic.

Results: Among 767 publications, 113 eligible articles published between 1972 and 2021 were identified, and prevalence estimates from 83 articles and incidence estimates from 12 articles were extracted. The pooled prevalence of any tinnitus among adults was 14.4% (95% CI, 12.6%-16.5%) and ranged from 4.1% (95% CI, 3.7%-4.4%) to 37.2% (95% CI, 34.6%-39.9%). Prevalence estimates did not significantly differ by sex (14.1% [95% CI, 11.6%-17.0%] among male individuals; 13.1% [95% CI, 10.5%-16.2%] among female individuals), but increased prevalence was associated with age (9.7% [95% CI, 7.4%-12.5%] among adults aged 18-44 years; 13.7% [95% CI, 11.0%-17.0%] among those aged 45-64 years; and 23.6% [95% CI, 19.4%-28.5%] among those aged ≥65 years; P < .001 among age groups). The pooled prevalence of severe tinnitus was 2.3% (95% CI, 1.7%-3.1%), ranging from 0.5% (95% CI, 0.3%-0.7%) to 12.6% (95% CI, 11.1%-14.1%). The pooled prevalence of chronic tinnitus was 9.8% (95% CI, 4.7%-19.3%) and the pooled prevalence of diagnosed tinnitus was 3.4% (95% CI, 2.1%-5.5%). The pooled incidence rate of any tinnitus was 1164 per 100 000 person-years (95% CI, 479-2828 per 100 000 person-years).

Conclusions and relevance: Despite the substantial heterogeneity among studies, this comprehensive systematic review on the prevalence and incidence of tinnitus suggests that tinnitus affects more than 740 million adults globally and is perceived as a major problem by more than 120 million people, mostly aged 65 years or older. Health policy makers should consider the global burden of tinnitus, and greater effort should be devoted to boost research on tinnitus.

Figure 1.. Forest Plot of Any Tinnitus Prevalence Among Adults, by Different Definition Classes of Any Tinnitus

In some articles, the number of cases and/or sample sizes might not coincide with those provided in the original study owing to the R package, which recalculates the percentage. We were interested in keeping the estimate provided; therefore, we modified numbers accordingly. A1 indicates the question “Have you experienced tinnitus?”; A2, “Have you experienced tinnitus for more than 5 minutes?”; A3, “Have you experienced tinnitus during the last months”?; A4, “During the last months, have you experienced tinnitus which lasts for more than 5 minutes?”; A5, assessment of tinnitus through a specific scale; A6, assessment of tinnitus via other tinnitus definitions; BG, Bulgaria; DE, Germany; ES, Spain; FR, France; GR, Greece; IE, Ireland; IT, Italy; LV, Latvia; PL, Polonia; PT, Portugal; RO, Romania; THI, Tinnitus Handicap Inventory; TQ, Tinnitus Questionnaire; and TSCHQ, Tinnitus Sample Case History Questionnaire. ^aThis study had 2 populations; the second population is indicated by “b.”

Figure 2.. Forest Plot of Pooled Prevalence, by Different Definitions of Severe Tinnitus in Adults

In some articles, the number of cases and/or sample sizes might not coincide with those provided in the original study owing to the R package, which recalculates the percentage. We were interested in keeping the estimate provided; therefore, we modified numbers accordingly. BG indicates Bulgaria; DE, Germany; ES, Spain; FR, France; GR, Greece; IE, Ireland; IT, Italy; LV, Latvia; PL, Polonia; PT, Portugal; RO, Romania; S1, “Are you bothered by your tinnitus?”; S2, “How much are you bothered by your tinnitus?”; S3, “Does your tinnitus interfere with sleep and concentration?”; S4, assessment of tinnitus severity through a specific scale; S5, assessment of tinnitus severity via other definitions of tinnitus severity; THI, Tinnitus Handicap Inventory; and TQ, Tinnitus Questionnaire. ^aThis study had 2 populations; the second population is indicated by “b.”