Tinnitus prevalence, associated characteristics, and related healthcare use in the United States: a population-level analysis

Abstract

Background: Tinnitus is a potentially disabling condition with few treatments. We examined the prevalence and characteristics of tinnitus among demographic groups in the United States (US) and assessed associated factors and tinnitus-related healthcare.

Methods: We included adults with and without bothersome tinnitus from the nationally representative 2014 National Health Interview Survey (NHIS; raw n = 36,697), the latest year with tinnitus data. We evaluated tinnitus prevalence and characteristics (frequency, severity, duration) overall and among groups defined by sex and race/ethnicity. Logistic regression with adjusted Wald tests were used for comparisons in NHIS-weighted populations by sex and race/ethnicity, and to evaluate associations between demographic/medical characteristics and noise exposure on tinnitus risk.

Findings: The US prevalence of tinnitus was 11.2% (95% CI: 10.8%, 11.7%; ∼27 million people) in 2014. Of those with tinnitus, 41.2% always had symptoms and 28.3% had ≥15 years symptom duration; the rates were significantly higher among men vs. women and non-Hispanic (nHW) vs. Hispanic Whites (HW), Blacks, or other ethnicity. Significantly more women vs. men and HW vs. nHW reported severe tinnitus. Sex and race/ethnicity, except Asian, were not significantly associated with tinnitus when age, otologic/medical disorders, and noise exposure were included in the model. Significantly lower rates of all minority groups discussed tinnitus with a doctor compared to nHW, and among those who did, Blacks were significantly less likely to receive tinnitus evaluation than nHWs.

Interpretation: Tinnitus prevalence varies across US demographic groups and racial differences were identified in the delivery of tinnitus-related healthcare.

Funding: Rich Robbins, Bertarelli Foundation Endowed Professorship.

Keywords: Health care equity; Hearing loss; National health interview survey; Otologic healthcare; Prevalence; Tinnitus; United States.

Fig. 1

Demographic and clinical characteristics of United States adults with and without tinnitus. (a) Distribution of people without vs. with tinnitus across United States census areas. (b) Age distribution of people with (red) and without (blue) tinnitus, by age category. (c) Proportions of survey respondents with and without tinnitus who were current, former, or never smokers. Smoking status was unknown for 36 respondents with tinnitus (0.9%) and 151 without tinnitus (0.5%). (d) Proportions of survey respondents with (red) and without (blue) tinnitus who reported that a healthcare provider had ever told them they had the listed medical conditions; sinusitis and hay fever were within the last 12 months. (e) Proportions of survey respondents with (red) and without (blue) tinnitus who reported that they had hearing-related symptoms, dizziness/imbalance within the last 12 months, or migraine within the last 3 months. All comparisons were conducted among the weighted population using single Adjusted Wald chi² tests for each category to avoid multiplicity. Error bars in panels b, d, and e represent 95% confidence intervals. The raw Ns of the comparative cohorts were 32,183 without tinnitus and 4514 with tinnitus; the only exception is that the comparison in (e) for ‘worse hearing in one ear’ was conducted among respondents reporting other than ‘excellent’ unassisted hearing quality (15,461 without tinnitus and 3736 with tinnitus). Refer to Supplementary Table S2 for full numerical results. Source: 2014 National Health Interview Survey Adult Sample File.

Fig. 2

Multinomial logistic regression model of factors associated with tinnitus. A multinomial logistic regression model was developed including categories of age group, race/ethnicity, hearing loss, dizziness imbalance, hyperacusis, high cholesterol, arthritis, very loud occupational noise exposure, very loud non-occupational noise exposure at least 10 times a year, ever using firearms, and being a current or former smoker. The base outcome was no tinnitus. The dependent variable was tinnitus, defined in the survey as being bothered by ringing, buzzing, or roaring in the ears/head that lasted at least 5 min in the past 12 months. All respondents with complete data on the listed variables were included in the model (n observations = 34,190; weighted population n = 222,850,027). The model F (21,280) = 123.78, (p < 0.0001). The area under the receiver operating characteristic curve was 0.83 (95% CI: 0.82, 0.83), indicating excellent fit (curve in Supplementary Figure S3). Abbreviations: AIAN, American Indian/Alaska Native; CI, confidence interval; RRR, relative risk ratio; ref, reference; y, years. ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001. Source: 2014 National Health Interview Survey Adult Sample File.