Tinnitus #1: The Demographics of Tinnitus

"I have severe hearing damage. It's manifested itself as tinnitus, ringing in the ears at frequencies that I play guitar. It hurts, it's painful, and it's frustrating"– Pete Townsend

It is not surprising that playing guitar for The Who over many years is a risk factor for developing tinnitus. Many tinnitus sufferers report a history of noise trauma that in many cases has ceased long before the tinnitus develops (Turner et al., 2012). However, tinnitus need not be associated with a long career in music, the military, or other vocations that involve exposure to loud sounds. As much as 25% of the United States population suffers from tinnitus (Bhatt et al., 2017), indicating a widespread problem that affects patients from all walks of life. Worse yet, despite significant efforts, no effective drug treatment is available to prevent or reduce tinnitus. This leaves patients with few options, including the use of hearing aids to try to regain some lost auditory function, or to use noise maskers or behavioral therapy to aid habituation to the symptoms or learn to ignore them, occasionally with poor results and continued severe impairment (Hesse, 2016). Understanding the effects of tinnitus on overall health, quality of life, and healthcare costs will help to explain the urgency guiding many biotechnology and pharmaceutical companies working on treatments today.

The Epidemiology of Tinnitus The largest analysis of tinnitus epidemiology in American adults was published in 2016 (Bhatt et al., 2016). This study extracted data from the 2007 National Health Interview Survey which identified adults reporting tinnitus symptoms in the preceding 12 months. These tinnitus sufferers numbered an estimated 21.4 million, representing approximately 9.6% of American adults. Over half of the respondents with tinnitus experienced it for more than 5 years, and 27% had symptoms for more than 15 years. 36% had symptoms almost constantly, and 25% reported a history of loud noise exposure at work (Bhatt et al., 2016).

Despite the fact that 27% of tinnitus sufferers identified by the 2007 National Health Interview Survey considered their tinnitus to be a moderate to severe problem, only half discussed their symptoms with a physician, and 85% of tinnitus patients had not tried any form of coping remedy (Bhatt et al., 2016). This likely reflects the helpless nature of the tinnitus problem confronting sufferers, which is all-too-often echoed by their health care providers.

Armed forces personnel are particularly at risk of suffering from tinnitus due to noise exposure in the military. The US Department of Veterans Affairs added 297,000 new veteran recipients of service-related benefits in 2017, and of these, 160,000 claimed tinnitus as a service-related disability. Tinnitus was therefore claimed by 54% of new benefit recipients, and was almost twice as common as the next most commonly claimed disabilities (limitation of knee flexion and hearing loss, with 83,000 and 82,000 claims, respectively) (2017 Annual Benefits Report, U.S. Department of Veterans Affairs).

The Bhatt study described above draws useful conclusions from one large set of data, but a lack of standardized diagnostic criteria limits the pooling of multiple data sets. A meta-analysis of 40

tinnitus studies (McCormack et al., 2016) showed, for example, that overall prevalence of tinnitus ranges from 5% to 43% of study populations. In those studies that reported tinnitus by age, prevalence increased with age from a range of 11-25% in 40-50 year-old patients, up to 15- 32% among patients age 70-80 years. Estimates of significant tinnitus severity varied from 3% to 31%, again reflecting variability of tinnitus reporting methods.

Widespread Problem Despite the variability of epidemiologic statistics, it is clear that tinnitus represents a widespread problem among the general population and especially among military personnel. Additionally, while many patients are suffering from relatively severe symptoms, the helpless nature of the tinnitus problem causes few to seek remedies to cope with the condition. In our next article, the cost of tinnitus in terms of financial implications and effect on quality of life will be reviewed.

References Bhatt, J.M., Bhattacharyya, N., & Lin, H.W. (2017). Relationships between tinnitus and the prevalence of anxiety and depression. Laryngoscope, 127(2): 466-469.

Bhatt, J.M., Lin, H.W., & Bhattacharyya, N. (2016). Tinnitus epidemiology: prevalence, severity, exposures, and treatment patterns in the United States. JAMA Otolaryngol Head Neck Surg, 142(10), 959-965.

Hesse, G. (2016). Evidence and evidence gaps in tinnitus therapy. GMS Curr Top Otolaryngol Head Neck Surg, 15, 1-42.

McCormack, A., Edmondson-Jones, M., Somerset, S., & Hall, D. (2016). A systematic review of the reporting of tinnitus prevalence and severity. Hearing Res, 337, 70-79.

Turner, J., Larsen, D., Hughes, L., Moechars, D., & Shore, S. (2012). Time course of tinnitus development following noise exposure in mice. J Neurosci Res, 90(7), 1480-1488.

Authors David Hicks, M.D.: Dr. Hicks directs business development at Turner Scientific, and has significant training and experience in clinical treatment of ear disorders. Contact: dhicks@turnerscientific.com

Jeremy Turner, Ph.D.: Dr. Turner is the founder and Chief Scientific Officer at Turner Scientific. He completed his Ph.D. in auditory neuroscience, and has more than 22 years’ experience in preclinical hearing loss, tinnitus, and ototoxicity research. Contact: jturner@turnerscientific.com

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