Tinnitus #3: The Effect on Quality of Life
The effect that tinnitus has on quality of life is quite variable. This is largely due to the diversity of tinnitus presentations: it can be acute or chronic, constant or intermittent, subtle or intense. The impact on tinnitus sufferers is therefore correlated with each patient’s individual experience. While many sufferers report minimal reduction in quality of life resulting from tinnitus (Teixeira et al., 2017), others report severe effects. For example, in a large cross- sectional study in Korea, 21% of tinnitus sufferers reported suicidal ideations, and 1.2% reported suicide attempts (Seo et al., 2016).
A survey of its members conducted by the American Tinnitus Association (ATA) in 2014 revealed many of the ways that tinnitus can impact a patient’s quality of life. More than 1,100 people with tinnitus responded, using a scale of 1 to 10 to describe how much tinnitus impacts their lives on a daily basis (1=low; 10=high). 20% of respondents rated the impact of tinnitus as 8, 9, or 10, and 54% rated the impact at 5 or higher. They also were asked what single symptom best describes how tinnitus affected their day-to-day lives. Only 38% responded that tinnitus was “annoying” but did not significantly impact their lives, or hard to notice. Of the remaining members, 18% described sleep problems, 16% mentioned trouble concentrating, 13% described anxiety, 7% chose social isolation or ongoing depression, and 2% described inability to work as their primary tinnitus-related complaints. The ATA also points out that family members, friends, and coworkers share the effects of tinnitus on each patient, as difficulty socializing and communication problems from tinnitus lead to frustration and irritability on the part of supporters (ATA website).
A common instrument for evaluating the impact of tinnitus is the Tinnitus Handicap Inventory (THI), which is composed of 25 questions related to how tinnitus interferes with daily life. When compared to the results of the World Health Organization Quality of Life (WHO QOL) questionnaire (which defines quality of life as “the individual’s perception of their life position within the context of culture systems and values in which they are inserted and related to their objectives, expectations, standards, and concerns” (Teixeira et al., 2017)), several THI questions were found to be especially predictive of a patient’s quality of life. Specifically, patients who rated highest with “feeling confused from tinnitus”, “trouble falling asleep”, “interference with job or household responsibilities”, “getting upset from tinnitus”, and “feeling of being depressed” had the lowest overall quality of life as measured by the WHO QOL questionnaire (Zeman et al., 2014).
It is clear that tinnitus is associated with immense suffering but that it is highly variable from person-to-person, affecting patients to different degrees and in different ways. All patients are at risk of diminished quality of life, though, and clinicians should be aware of the most common consequences of tinnitus that reduce quality of life (sleep problems, trouble concentrating, sleep issues, etc.). Clinicians could also play a more effective role by learning the best ways to ask about the effects of tinnitus, and sharing with patients the hope that improved quality of life and relief might be possible through therapies that help the sufferer learn to control or accept the condition. But learning to accept a medical symptom like tinnitus is not a satisfying
resolution. It clearly isn’t sufficient to just learn to accept your high blood pressure, your memory problems, sleeping issues, or depression, so why would it be acceptable to just learn to accept your tinnitus? We must keep marching forward until we find an effective cure for tinnitus.
References American Tinnitus Association: Impact of Tinnitus (2018) (available at https://www.ata.org/understanding-facts/impact-tinnitus).
Seo, J.H., Kang, J.M., Hwang, S.H., Han, K.D., & Joo, Y.H. (2016). Relationship between tinnitus and suicidal behaviour in Korean men and women: a cross-sectional study. Clin Otolaryngol, 41(3), 222-227.
Teixeira, A.R., Rosito, L.P.S., Goncalves, A.K., Nunes, M.G.P., Dornelles, S., & Olchik, M.R. (2017).
Tinnitus in elderly individuals: discomfort and impact in the quality of life. Int Arch Otorhinolaryngol, 21, 66-71.
Zeman, F., Koller, M., Langguth, B., Landgrebe, M., & Tinnitus Research Initiative Database Study Group. (2014). Which tinnitus-related aspects are relevant for quality of life and depression: results from a large international multicentre sample. Health Qual Life Outcomes, 12(7), 1-10.
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: email@example.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: firstname.lastname@example.org