1. DISCUSSION & CONCLUSIONS
Risk Factors for Self-Reported Tinnitus in US Youth: Data from the NHANES ( )
Michael Skelton, AuD, CCC-A, Ishan Bhatt, PhD, CCC-A & O’neil Guthrie, PhD, CCC-A
Communication Sciences and Disorders, Northern Arizona University
BACKGROUND
Tinnitus is a global hearing health concern known to affect individuals across a lifespan (Sanchez, 2004; Park et al, 2014).
Research suggests that tinnitus prevalence varies from 7% - 47% in adolescents and children who are able to describe tinnitus when questioned, but unlikely to complain about it spontaneously. (Raj-Koziak et al, 2013; Mahboubi et al., 2013 & Kim et al, 2013)
PURPOSE OF THE STUDY
The purpose of this study was to investigate the prevalence and risk-factors for tinnitus in US youth aged years using the National Health and Nutrition Examination Survey (NHANES ) data.
Race/ethnicity was re-coded into non-Hispanic white, non-Hispanic black, Hispanic and other races (including multiracial).
Firearms noise exposure was considered positive if a participant answered positively to the question: Have you ever used firearms for target shooting, hunting, or for any other purposes?
Work-related noise exposure was defined as positive if a participant answered positively to the question: Have you ever had a job where you were exposed to loud noise for five or more hours a week?
Music exposure was defined as positive if a participant identified exposure to loud noise or music for five or more hours per week outside of a job.
History of smoking was considered positive if a participant answered positively to any of the following questions: Have you ever tried smoking? or Does anyone smoke at home?
RESULTS
Prevalence of tinnitus in the entire sample: 6.8 % (160 participants)
Risk-factors for the self-reported tinnitus: Binary logistic regression analysis with tinnitus as a dependent variable and other above listed factors as dependent variables were used to identify risk-factors for tinnitus. The analysis found that males showed significantly lower prevalence of tinnitus compared to females. Participants with a history of firearm noise exposure, noisy job, music exposure and smoking showed significantly higher prevalence of tinnitus (Table 1).
Table 1. Results of the binary logistic regression analysis
(Nagelkerke R2 = 0.056)
Repeated measure ANOVA found that participants with tinnitus showed significantly elevated hearing thresholds in both ears, with FRight ear (1, 2343) = 11.10, p = and FLeft ear (1, 2344) = 8.686, p =
26.3% (42 participants) reported that they were bothered by tinnitus when going to sleep. Almost 60% participants reported tinnitus as a significant problem in their life.
RESULTS (continued)
Figure: Hearing thresholds of participants with and without tinnitus
Importantly, among 926 participants with no history of noise exposure, music exposure, firearm noise exposure, or smoking, 39 participants reported tinnitus (22.5% of tinnitus group).
On the contrary, among 33 participants with positive history of noise exposure, music exposure, firearm noise exposure, and smoking, 27 participants (81.8%) did not report tinnitus.
METHODS
NHANES database for the study
Audiometric testing was performed as an annual, ongoing, cross-sectional survey by the mobile examination center and health technicians from the National Center for Health Statistics (NHANES).
Data was collected through household interviews followed by a standardized physical examination. Demographic and audiometric databases from NHANCES , and were merged together respectively.
Individuals ranging in age from years with bilateral normal otoscopic findings, compliance value ranges from 0.2 to 1.8 cc, and middle ear pressure ranging from -50 to 25 dapa in both ears were considered for the further analysis. Total of 2348 participants following the inclusion criteria were selected for this study.
Audiometric Measures
Interacoustic model AD226 audiometer with standard TDH-39 headphones were used to measure hearing sensitivity. Testing was conducted according to a modified Hughson Westlake procedure using the automated testing mode of the audiometer.
Demographic and Survey data
Tinnitus was considered present if a participant answered positive to: In the past 12 months, have you been bothered by ringing, roaring, or buzzing in your ears or head that lasts for 5 minutes or more?
Sex of the participants was categorized as male and female.
Socioeconomic status was estimated from poverty/income ratio (PIR) in three categories: low (PIR≤1.3), middle (PIR from 1.4 to 3.5) and high (PIR more than 3.5).
Age of participants was categorized in four subgroups: years, years, years, and years.
Dependent Variables
Odds Ratio
p Value
Test year
1.006
.912
Sex
.643
.019
Income
.904
.390
Age
.950
.236
Race
.961
.685
Firearms
1.614
.036
Noisy Job
1.770
.045
Music Exposure
1.787
.002
Smoking
1.502
.032
DISCUSSION & CONCLUSIONS
Noise exposure, music exposure, firearms noise exposure, and smoking are predominant factors associated with tinnitus perception in young adults.
Females are more susceptible to tinnitus perception than males.
A large portion of variance in the regression analysis remains unexplained by the environmental and health-related factors.
Our study indicated that tinnitus is a complex audiological disorder with multiple triggering factors. Personal susceptibility to these factors might be associated with the effect of multiple genetic variants in combination with lifestyle and environmental factors.
Genetic association analyses are recommended to explore physiological basis of tinnitus.