Tinnitus common, but care may not mesh with current guidelines, study finds
Fewer than half of patients discussed their tinnitus with a physician, and of those that had, medications were discussed most frequently.
Tinnitus occurs in approximately 1 in 10 U.S. adults, but treatment may not follow that recommended in recent guidelines, according to a recent study.
Researchers used data from the 2007 National Health Interview Survey to examine the epidemiologic features and effects of tinnitus in the U.S. and to compare usual management with recommendations in the 2014 guidelines from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF). Prevalence, severity, duration, and regularity of tinnitus were quantified, and data on noise exposure and on management patterns during clinician visits were analyzed. The study results were published online July 21 by JAMA Otolaryngology-Head & Neck Surgery.
Of an estimated 222.1 million U.S. adults 18 years of age or older (raw data, 75,764 adults), 21.4 million (9.6%) had had tinnitus in the past 12 months. Of these, 56.1% had had symptoms for more than 5 years and 27.0% had had symptoms for more than 15 years. Thirty-six percent reported nearly constant symptoms, 15.0% reported noticeable symptoms at least once per day, 14.6% reported noticeable symptoms at least once per week, and the remaining patients reported less than weekly symptoms. Tinnitus was more prevalent in men than in women (10.5% vs. 8.8%), but severity did not differ significantly by sex. Rates of tinnitus were higher in adults who reported consistent exposure to loud noises at work and during recreation (odds ratios, 3.3 [95% CI, 2.9 to 3.7] and 2.6 [95% CI, 2.3 to 2.9], respectively).
Overall, 7.2% reported that their tinnitus was a big or very big problem, 20.2% said it was a moderate problem, and 41.6% reported that it was a small problem, while the remaining 31.0% reported that their tinnitus did not bother them. Fewer than half of patients (49.4%) said they had discussed their tinnitus with a physician, and of those that had, medications were the potential intervention discussed most frequently (45.4%). Dietary supplements were discussed by 7.8% of patients, hearing aids were discussed by 9.2%, wearable masking devices and nonwearable masking devices were discussed by 2.6% and 2.3%, and cognitive-behavioral therapy was discussed by 0.2%. The 2014 AAO-HNSF guidelines do not recommend medical therapy and dietary supplements but do recommend hearing aids, cognitive-behavioral therapy, and masking devices.
The authors noted that their study was retrospective in nature and was subject to recall bias. In addition, they pointed out that it used 2007 data and may not reflect current management of tinnitus. However, they concluded that based on their findings, tinnitus affects a significant proportion of U.S. adults, especially those who report regular exposure to noise.
“The recent guidelines published by the AAO-HNSF provide a logical framework for clinicians treating these patients, but the current results indicate that most patients may not be offered management recommendations consistent with the suggested protocol,” the authors wrote. They called for future studies to examine changing patterns in tinnitus care before and after the guidelines' publication.