Associations Between Tinnitus and Systemic Disease in Adolescents: Implications of Vitamin D Deficiency and Anaemia

OBJECTIVES

Tinnitus is one of the irritating symptoms that should be addressed in adolescents. Since tinnitus affects mental health, it is important to treat it. However, identifying the cause of tinnitus is very challenging and the treatment strategies of tinnitus are controversial. The objective of this study was to identify the prevalence of tinnitus in adolescents and systemic diseases as risk factors of adolescent tinnitus to find evidence for new treatment strategies.

MATERIALS AND METHODS

We extracted the subjects and data using the 5th Korea National Health and Nutrition Examination Survey from 2010 to 2012. One thousand five hundred ninety-three adolescents with bilateral normal tympanic membranes and availability of the results of physical, laboratory and audiological examinations, were selected. We evaluated their systemic diseases based on these results and assessed the association of tinnitus with demographic factors, systemic diseases and hearing levels.

RESULTS

The prevalence of tinnitus in Korean adolescents was 21.7%. The hearing level was not associated with tinnitus. Tinnitus was significantly associated with age (p = 0.005), 25(OH)-D level (p = 0.007) and anaemia (p = 0.003). After controlling the other factors, age (p = 0.045), 25(OH)-D level (p = 0.041) and anaemia (p = 0.019) were independently related to tinnitus.

CONCLUSION

Tinnitus in adolescents was significantly associated with age, vitamin D and anaemia. Physicians should consider the higher likelihood of these deficiencies or diseases in adolescent tinnitus patients. Additionally, recognizing these associations may be helpful in developing treatment strategies for adolescent tinnitus.

Associations Between Physical Activity, Tinnitus, and Tinnitus Severity

OBJECTIVES

To examine the associations between physical activity and tinnitus development and physical activity and tinnitus severity in a large representative sample of US adults.

DESIGN

Data were obtained from 3826 eligible participants (20 to 69 years) in the National Health and Nutrition Examination Survey between 2015 and 2016. Physical activity was assessed using a Global Physical Activity Questionnaire. We used multivariable logistic regression to test the associations of physical activity (without physical activity, with physical activity) and amount of physical activity (min/week, in quartiles) with tinnitus symptoms. Adults with depressive symptoms were excluded, and the models were controlled for relevant sociodemographic, lifestyle, and health-related covariates. A restricted cubic spline was used to explore the dose-response relationship between the amount of physical activity and tinnitus.

RESULTS

Overall, 12.8% of the population who engaged in physical activity reported tinnitus, compared with 18.5% of the population who did not ( p = 0.005). Subgroup analysis based on the amount of physical activity showed that participants who performed physical activity (150 to 300, 310 to 540, and 550 to 4800 min/week) had lower risks of tinnitus than those with no physical activity (odds ratio = 0.72, 0.56, and 0.62, respectively), after adjusting for covariates. However, no correlation was observed between physical activity and tinnitus severity in the present study. The dose-response analysis showed a nonlinear relationship (P for nonlinearity = 0.04) between the amount of physical activity and the risk of tinnitus.

CONCLUSIONS

Physical activity may be associated with a reduced risk of tinnitus. Further research using a longitudinal design is required to confirm these findings and clarify the direction of causation.

The efficacy of acoustic therapy versus oral medication for chronic tinnitus: A meta-analysis

PURPOSE

To compare the efficacy of acoustic therapy (AT) and drug therapy (DT) for chronic tinnitus.

METHODS

We searched Pubmed, ScienceDirect, Chinese Journal Full-text Database (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), Embase, and Cochrane Library from the establishment of the database to December 2019. Meta-analysis was performed on the Tinnitus Handicap Inventory (THI) score and Visual Analogue Scale (VAS) with included literature using Revman 5.3 software.

RESULTS

A total of 18 documents were included, including 16 Chinese documents and 2 English documents, with 1774 patients (including 962 patients treated with AT and 812 patients treated with DT). The effect of AT (by the number of cases or ears) is better than that of DT (P < 0.05). After treatment, the THI value of AT was more evident than that of DT (WMD = -4.25, (-13.24, -5.29)). And the VAS value of AT was significantly lower than that of DT (WMD = -0.73, (-1.31, -0.15)).

CONCLUSION

Compared with DT, AT can significantly improve the efficacy of tinnitus and reduce the symptoms of tinnitus patients. Clinically, it can vigorously promote the application value of treating tinnitus by sound.

Associations of Earphone Use with Tinnitus and Anxiety/Depression

Objective:

This study aimed to investigate the association of earphone use with audiologic and psychologic factors.

Materials and methods:

Korea National Health and Nutrition Examination Survey 2010–2012 data were collected for participants aged ≥12 years old with earphone use ≥1 hour/day. They were matched to a control group for age, sex, income, and education level. The relationship between earphone use and the hearing thresholds of pure-tone audiometry, tinnitus, and psychologic factors such as depression and anxiety, and other quality of life variables was analyzed using multiple logistic regression tests with complex sampling.

Results:

Among the participants, 22.9% (449/1955) of earphone users and 18.1% (355/1600) of control participants had tinnitus (P < 0.001). Earphone users showed 1.27-times higher odds for tinnitus (95% confidence interval [CI] = 1.09–1.50, P = 0.003). Moreover, 6.5% (128/1955) of earphone users and 5.0% (97/1600) of control participants had anxiety and depressive symptoms (P = 0.033). Earphone users showed 1.32-times higher odds for anxiety and depressive symptoms (95% CI = 1.14–1.52, P = 0.040). Nevertheless, the hearing thresholds were comparable between earphone users and control participants.

Conclusion:

Earphone use was associated with tinnitus and anxiety or depressive symptoms.

Auditory brainstem response test results in normal hearing adolescents with subjective tinnitus

OBJECTIVES

The objective of the study was to analyze the auditory brainstem response (ABR) test results of adolescents with normal hearing threshold who have subjective tinnitus in an effort to determine the probable site of origin of tinnitus.

METHODS

Among the patients who visited the outpatient clinic of the Department of Otolaryngology at our tertiary hospital from January 2016 to December 2019, adolescents aged 13-18 years with the chief complaint of unilateral subjective tinnitus and pure tone audiometry (PTA) within 25 dB HL were enrolled and retrospectively reviewed. The ABR test parameters (amplitudes and latencies of waves I, III, and V and interpeak latencies [IPLs] of waves I-III, III-V, and I-V) were analyzed and compared between tinnitus ears and contralateral ears without tinnitus. Study participants were divided into the chronic tinnitus (tinnitus duration ≥6 months) and non-chronic tinnitus (tinnitus duration <6 months) groups, and the difference between the two groups was analyzed.

RESULTS

Ten adolescents were included in the study, and their ABR test results were reviewed. IPL III-V was significantly prolonged in tinnitus ears compared to non-tinnitus ears (p = 0.035). Although other parameters were found to be statistically non-significant, there was preponderance in ABR wave I amplitude; it was smaller in tinnitus ears of chronic tinnitus adolescents than in those of non-chronic tinnitus adolescents (p = 0.114).

CONCLUSION

The probable site of origin of tinnitus in adolescents with normal hearing might be in the upper brainstem of the auditory pathway. Further analysis of ABR test results in adolescents with tinnitus and normal hearing can help clarify the pathophysiology of tinnitus in adolescents.

[Key factors of the severity of chronic subjective tinnitus: a complex network analysis]

Objective:To investigate the key factors related to the severity of chronic subjective tinnitus through a complex network analysis. Methods:A retrospective study about patients with chronic subjective tinnitus presented to Peking Union Medical College Hospital from December 2019 to October 2020 was conducted. The demographic information, audiometric and tinnitus-related tests, and scores of Tinnitus Handicap Inventory（THI）, Hospital Anxiety and Depression Scale（HADS）, Pittsburgh Sleep Quality Index（PSQI） and Visual Analogue Scale（VAS） of tinnitus loudness and annoyance were set as nodes in a complex network which was conducted and analyzed through the R package. Results:A total of 183 patients were enrolled, including 99（54.1%） males and 84（45.9%） females, with an average age of（41.65±1.05） years. The results of the complex network analysis showed that anxiety and sleep disorder were closely related to THI score, and anxiety was more important than sleep disorder. There was a strong correlation between self-reported anxiety and insomnia. Demographic characteristics, audiologic and tinnitus-associated tests were not significantly related to THI score. Conclusion:Anxiety and sleep disturbance were key factors related to tinnitus severity, and anxiety played a more important role. There was an obvious correlation between sleep disorder and anxiety, and they might have a superimposed effect on tinnitus severity. Future therapies of tinnitus should pay more attention on releasing anxiety and insomnia.

Hearing impairment and diverse health outcomes : An umbrella review of meta-analyses of observational studies

BACKGROUND

Globally, it is estimated that approximately 1.3 billion people live with some form of hearing impairment. Major causes of hearing loss include infection/disease, age-related factors, and occupational factors. Numerous systematic reviews and meta-analyses have attempted to synthesise literature on these topics. To date there has not been a systematic evaluation of the relationships between hearing impairment and diverse physical, mental, and social outcomes.

OBJECTIVE

We performed an umbrella review of systematic reviews of observational studies with meta-analyses for any physical disease, biomarkers of disease, mental health or cognitive outcomes, and/or modifiable risk factors associated with hearing impairment.

METHODS

For each meta-analytic association, random effects summary effect size, 95% confidence intervals, heterogeneity, evidence for small-study effect, excess significance bias and 95% prediction intervals were calculated, and risk of bias was assessed via the AMSTAR2 tool. These were used to grade significant evidence (p < 0.05) from I to IV, using the recommendations from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

From 3747 studies, 21 were included covering 54 outcomes. Overall, 44/54 outcomes (82%) yielded significant results. Of the highest quality evidence, age-related hearing loss and non-specific hearing impairment were negatively associated with several types of cognitive impairments; pediatric bilateral hearing loss was negatively associated with quality of life, sensorineural hearing loss was positively associated with rheumatoid arthritis and tinnitus was positively associated with temporomandibular disorders.

CONCLUSION AND RELEVANCE

Results show moderate quality evidence for associations between several types of hearing impairments and cognitive difficulties, quality of life and systemic diseases such as rheumatoid arthritis. Practitioners and public health policies should note these findings when developing relevant healthcare policies.

Exposure to leisure noise and intermittent tinnitus among young adults in Bavaria: longitudinal data from a prospective cohort study

OBJECTIVES

To investigate the association between total leisure noise exposure and intermittent tinnitus among young adults.

DESIGN

Data were obtained from the Ohrkan study, an ongoing prospective cohort study conducted in South Germany since 2009. Information about exposure to impulse and leisure noise, tinnitus occurrences, sociodemographic variables, and self-rated hearing ability were analysed at four time points over a period of seven and a half years.

STUDY SAMPLE

Participants of the Ohrkan cohort study, who provided data about the occurrence of tinnitus for all surveys (n = 1028).

RESULTS

Intermittent tinnitus was reported in the majority of the sample (60%). The risk for intermittent tinnitus increased with higher sound pressure levels from exposure to leisure noise (full model (Odds Ratio, 95%CI): 80-<85dB(A): 1.41 [1.13-1.78], 85-<90dB(A): 1.73 [1.38-2.16], >90dB(A): 2.04 [1.59-2.61]). Visiting nightclubs was a major contributor to this relationship. Of the considered covariables, self-rated hearing as "poor", and growing up in a single-parent household were significantly associated with intermittent tinnitus.

CONCLUSION

Intermittent tinnitus is very frequent among young adults and is associated with high levels of leisure noise exposure. To prevent intermittent tinnitus, reduced sound pressure levels and the use of hearing protection are necessary.

Prevalence, associated factors, and comorbidities of tinnitus in adolescents

The aim of this study was to investigate the prevalence of tinnitus among adolescents, and the factors known or hypothesized to be associated with tinnitus. Based on random sampling of school types and regions, a nationwide hearing survey of the first-year middle and high school students of South Korea was performed. The subjects underwent an otologic examination followed by pure tone audiometry up to 8 kHz. Questionnaires about the factors associated with hearing and tinnitus were completed by the students and their parents. Among the 1,593 subjects who completed the questionnaire and underwent pure tone audiometry, the prevalence of tinnitus was 46.0% and that of severe tinnitus was 9.1%. Tinnitus was associated with age, female gender, history of ear infection and sinusitis, leisure noise exposure due to karaoke and local-area-network gaming, alcohol consumption, and cigarette smoking. Noticeable hearing loss was not detected but participants with tinnitus complained of difficulty with sound localization, hearing in noise, and verbal working memory and were more susceptible to fatigue. The subjects with tinnitus also suffered more physical and mental health problems than did those without tinnitus. Thus, protection of the ears from noise and appropriate counseling should be considered for adolescents with tinnitus.

Noise exposure limit for children in recreational settings: Review of available evidence

It is universally recognized that prolonged exposure to high levels of non-impulsive noise will lead to noise-induced hearing loss. These high levels of noise have traditionally been found in an occupational setting, but exposure to high levels of noise is increasingly common in recreational settings. There is currently no established acceptable risk of hearing loss in children. This review assumed that the most appropriate exposure limit for recreational noise exposure in children would be developed to protect 99% of children from hearing loss exceeding 5 dB at the 4 kHz audiometric test frequency after 18 years of noise exposure. Using the ISO 1999:2013 model for predicting hearing loss, it was estimated that noise exposure equivalent to an 8-h average exposure (L_EX) of 82 dBA would result in about 4.2 dB or less of hearing loss in 99% of children after 18 years of exposure. The 8-h L_EX was reduced to 80 dB to include a 2 dB margin of safety. This 8-h L_EX of 80 dBA is estimated to result in 2.1 dB or less of hearing loss in 99% of children after 18 years of exposure. This is equivalent to 75 dBA as a 24-h equivalent continuous average sound level.

Salicylate increased ascorbic acid levels and neuronal activity in the rat auditory cortex

IMPORTANCE

Clinical observations have implied a central origin for tinnitus and potential therapeutic effects of ascorbic acid (AA); however, the detailed mechanisms remain undetermined.

OBJECTIVE

To investigate changes in the AA levels and neural activity in the auditory cortex (AC) during salicylate-induced tinnitus.

METHODS

Rats were randomly divided into 3 groups: (1) saline group, which received an intraperitoneal saline injection; (2) SS group, which received an intraperitoneal sodium salicylate (SS) injection (350 mg/kg); and (3) SS+Lido group, which received an intraperitoneal SS injection (350 mg/kg) and lidocaine delivered to the AC by microdialysis. For each group, we firstly used an in vivo microdialysis technique to investigate the concentrations of AA in the AC; and secondly, we recorded the neural activity in the AC using a single-unit recording technique.

RESULTS

The AA concentration in the SS group significantly increased after SS injection, whereas that of the saline group did not change. The AA concentration in the SS+Lido group also showed an increasing trend but was significantly lower than that in the SS group. In the electrophysiological study, the spontaneous firing rate of the SS group was significantly higher than that of the saline group. In addition, the proportion of short interval discharges was also higher in the SS group than in the saline group. Both differences were reversed by lidocaine treatment.

INTERPRETATION

Our data suggest that the elevation of AA levels in the AC may be related to increased neuronal activity, which may represent the mechanism underlying salicylate-induced tinnitus.

Effects of Non-traumatic Noise and Conductive Hearing Loss on Auditory System Function

The effects of traumatic noise-exposure and deafening on auditory system function have received a great deal of attention. However, lower levels of noise as well as temporary conductive hearing loss also have consequences on auditory physiology and hearing. Here we review how abnormal acoustic experience at early ages affects the ascending and descending auditory pathways, as well as hearing behavior.