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Natarajan N, Batts S, Gombar S, Manickam R, Sagi V, Curhan SG, Stankovic KM. Associations of Tinnitus Incidence with Use of Tumor Necrosis Factor-Alpha Inhibitors among Patients with Autoimmune Conditions. J Clin Med 2023; 12:jcm12051935. [PMID: 36902722 PMCID: PMC10004033 DOI: 10.3390/jcm12051935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Tumor necrosis factor-alpha (TNFα) may promote neuroinflammation prompting tinnitus. This retrospective cohort study evaluated whether anti-TNFα therapy influences incident tinnitus risk among adults with autoimmune disorders and no baseline tinnitus selected from a US electronic health records database (Eversana; 1 January 2010-27 January 2022). Patients with anti-TNFα had ≥90-day history pre-index (first autoimmune disorder diagnosis) and ≥180-day follow-up post-index. Random samples (n = 25,000) of autoimmune patients without anti-TNFα were selected for comparisons. Tinnitus incidence was compared among patients with or without anti-TNFα therapy, overall and among at-risk age groups or by anti-TNFα category. High-dimensionality propensity score (hdPS) matching was used to adjust for baseline confounders. Compared with patients with no anti-TNFα, anti-TNFα was not associated with tinnitus risk overall (hdPS-matched HR [95% CI]: 1.06 [0.85, 1.33]), or between groups stratified by age (30-50 years: 1 [0.68, 1.48]; 51-70 years: 1.18 [0.89, 1.56]) or anti-TNFα category (monoclonal antibody vs. fusion protein: 0.91 [0.59, 1.41]). Anti-TNFα was not associated with tinnitus risk among those treated for ≥6 months (hdPS-matched HR [95% CI]: 0.96 [0.69, 1.32]) or ≥12 (1.03 [0.71, 1.5]), or those with RA (1.16 [0.88, 1.53]). Thus, in this US cohort study, anti-TNFα therapy was not associated with tinnitus incidence among patients with autoimmune disorders.
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Affiliation(s)
- Nirvikalpa Natarajan
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA 94304, USA
| | - Shelley Batts
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA 94304, USA
| | - Saurabh Gombar
- Atropos Health, 71 W 83rd St #3R., New York, NY 10024, USA
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Raj Manickam
- Atropos Health, 71 W 83rd St #3R., New York, NY 10024, USA
| | - Varun Sagi
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA 94304, USA
| | - Sharon G. Curhan
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115, USA
| | - Konstantina M. Stankovic
- Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA 94304, USA
- Department of Neurosurgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, CA 94304, USA
- Wu Tsai Neuroscience Institute, Stanford University, 288 Campus Dr, Stanford, CA 94305, USA
- Correspondence:
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Neuroinflammation in Tinnitus. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Purpose of Review
The current review aims to explore recent studies that have illustrated a link between neuroinflammation and tinnitus and the consequential effect on neuronal functioning. We explore parallels amongst pain and tinnitus pathologies and a novel treatment option.
Recent Findings
Genetic and pharmacological blockage of pro-inflammatory cytokines mitigates the physiological and behavioral tinnitus phenotype in acute rodent models. In addition, recent pain studies target a signaling pathway to prevent the transition from acute to chronic neuropathic pain, which could translate to tinnitus.
Summary
Neuroinflammation likely mediates hyperexcitability of the auditory pathway, driving the development of acute tinnitus. In chronic tinnitus, we believe translational regulation plays a role in maintaining persistent tinnitus signaling. We therefore propose this pathway as a potential therapeutic strategy.
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Su SYS, Chien WC, Chung CH, Su WF, Fu E. Association of periodontitis with tinnitus: A population-based cohort study in Taiwan. J Clin Periodontol 2022; 49:970-979. [PMID: 35634696 DOI: 10.1111/jcpe.13670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/21/2022] [Accepted: 05/18/2022] [Indexed: 12/16/2022]
Abstract
AIM Tinnitus, ringing in the ears, is speculated to be driven by inflammation. This study examined whether periodontitis is a risk factor for tinnitus using Taiwan's National Health Insurance Research Database. MATERIALS AND METHODS Among the 79,456 patients who visited for dental concerns, 11,055 patients who were diagnosed with periodontitis and underwent periodontal treatment between 2000 and 2015 were enrolled in Group 1. After matching for sex, age, and index year, 11,055 patients with periodontitis who received no treatment were enrolled in Group 2. Similarly, 11,055 participants without periodontitis were included as controls. RESULTS At the end of the follow-up, 412 and 404 participants in the two periodontitis groups and 321 participants in the control group had tinnitus. Cumulative risk for tinnitus in Group 1 or 2 was significantly greater than in the control group. More periodontitis patients than controls developed tinnitus (adjusted hazard ratios were 1.71 (95% confidence interval [CI]: 1.49-1.97, p < .001) and 1.64 (95% CI: 1.37-1.86, p < .001) in Groups 1 and 2, respectively). The risks were not significantly different between Groups 1 and 2. Similar findings were obtained after excluding data for the first 1 or 5 years. CONCLUSIONS The study findings indicate that periodontitis is associated with tinnitus.
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Affiliation(s)
- Suzanne Ying-Shan Su
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wan-Fu Su
- Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Earl Fu
- Department of Dentistry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Mennink LM, Aalbers MW, van Dijk P, van Dijk JMC. The Role of Inflammation in Tinnitus: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:1000. [PMID: 35207270 PMCID: PMC8878384 DOI: 10.3390/jcm11041000] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 12/24/2022] Open
Abstract
Subjective tinnitus is the perception of sound without the presence of an external source. Increasing evidence suggests that tinnitus is associated with inflammation. In this systematic review, the role of inflammation in subjective tinnitus was studied. Nine animal and twenty human studies reporting inflammatory markers in both humans and animals with tinnitus were included. It was established that TNF-α and IL-1β are increased in tinnitus, and that microglia and astrocytes are activated as well. Moreover, platelet activation may also play a role in tinnitus. In addition, we elaborate on mechanisms of inflammation in tinnitus, and discuss potential treatment options targeting inflammatory pathways.
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Affiliation(s)
- Lilian M. Mennink
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.W.A.); (J.M.C.v.D.)
- Department of Otorhinolaryngology/Head & Neck Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Research School of Behavioral and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Marlien W. Aalbers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.W.A.); (J.M.C.v.D.)
- Research School of Behavioral and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Pim van Dijk
- Department of Otorhinolaryngology/Head & Neck Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Research School of Behavioral and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
| | - J. Marc C. van Dijk
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.W.A.); (J.M.C.v.D.)
- Research School of Behavioral and Cognitive Neurosciences (BCN), University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands
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Li ZC, Fang BX, Yuan LX, Zheng K, Wu SX, Zhong N, Zeng XL. Analysis of Studies in Tinnitus-Related Gene Research. Noise Health 2021; 23:95-107. [PMID: 34975125 PMCID: PMC8772442 DOI: 10.4103/nah.nah_57_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Summarize and analyze the current research results of tinnitus-related genes, explore the potential links between the results of each study, and provide reference for subsequent studies. Methods Collect and sort out the research literature related to tinnitus genes included in PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform before December 31, 2019. Then the relevant contents of the literature were sorted out and summarized. Results Fifty-one articles were finally selected for analysis: 31 articles (60.8%) were classified as researches on animal models of tinnitus, and 20 (39.2%) as researches on tinnitus patients. Existing studies have shown that genes related to oxidative stress, inflammatory response, nerve excitation/inhibition, and nerve growth are differentially expressed in tinnitus patients or animal models, and have presented the potential links between genes or proteins in the occurrence and development of tinnitus. Conclusion The research on tinnitus-related genes is still in the exploratory stage, and further high-quality research evidence is needed.
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Affiliation(s)
- Zhi-Cheng Li
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bi-Xing Fang
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Sun Yat-sen University, China
| | - Lian-Xiong Yuan
- Department of Science and Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ke Zheng
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shi-Xin Wu
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Nanbert Zhong
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, New York, USA
| | - Xiang-Li Zeng
- Department of Otolaryngology, Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Shulman A, Wang W, Luo H, Bao S, Searchfield G, Zhang J. Neuroinflammation and Tinnitus. Curr Top Behav Neurosci 2021; 51:161-174. [PMID: 34282564 DOI: 10.1007/7854_2021_238] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Neuroinflammation is the central nervous system's response to: injury, infection, and abnormal neural activity. Inflammatory processes are known to mediate many diseases, and recently evidence indicates that neuroinflammation underlies hearing disorders such as presbyacusis, middle-ear disease, ototoxicity, noise-induced hearing loss, and tinnitus. This chapter provides a review of the role of neuroinflammation in the etiology and treatment of tinnitus. Specifically, our research team has demonstrated that both tumor necrosis factor alpha (TNF-α) and calpain signaling pathways are involved in noise-induced tinnitus and that blocking them yielded therapeutic effects on tinnitus. Other efforts such as controlling acute inflammatory response via specialized pro-resolving mediators may help provide insight into preventing and treating tinnitus-related inflammatory processes.
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Affiliation(s)
- Abraham Shulman
- Department of Otolaryngology, State University New York-Downstate, Brooklyn, NY, USA.
| | - Weihua Wang
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Hao Luo
- Department of Otolaryngology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Shaowen Bao
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Grant Searchfield
- Section of Audiology, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Jinsheng Zhang
- Department of Otolaryngology, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Communication Sciences and Disorders, Wayne State University College of Liberal Arts and Sciences, Detroit, MI, USA
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Juan YH, Hsu CT, Hwang JH. Outcomes of Triple-Combination Therapy for Chronic Tinnitus. In Vivo 2020; 33:1707-1712. [PMID: 31471428 DOI: 10.21873/invivo.11660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIM Patients with tinnitus suffer not only from auditory dysfunction but also physical, mental, and social difficulties. Our aim was to investigate the outcomes of our triple-combination therapy for chronic tinnitus, which includes narrow-band noise masking, auricular acupuncture and cognitive behavioral therapy. PATIENTS AND METHODS The tinnitus handicap inventory (THI) scores of 78 adults with chronic tinnitus who received triple-combination therapy for 12 weeks were analyzed retrospectively. RESULTS There were 39 females and 39 males in this study. The mean age was 60.5 years [standard deviation (SD)=13.0, range=27-88 years] for all subjects. Mean pure tone average=39.5 decibel hearing level (SD=23.09). Pre-treatment mean THI score was 41.4 (SD=21.13), functional (F) subscore was 17.9 (SD=10.69), emotional (E) subscore was 10.6 (SD=6.87), and catastrophic (C) subscore was 12.9 (SD=4.85). Post-treatment THI total score was significantly lower compared to pre-treatment THI total score. Also, post-treatment subscores were significantly lower compared to pre-treatment subscores in F and C subsocres, but not in E subscore. In addition, multivariate logistic regression analysis showed that coffee and tea consumption was significantly positively associated with a reduction of THI total score. CONCLUSION Triple-combination therapy could be helpful for chronic tinnitus patients. It seemed that coffee and tea consumption may elicit increased improvement in conjunction with combined therapy for chronic tinnitus.
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Affiliation(s)
- Ying-Hsu Juan
- Department of Traditional Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, R.O.C.,Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, R.O.C.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C
| | - Chiu-Tien Hsu
- Department of Clinical Psychology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, R.O.C
| | - Juen-Haur Hwang
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan, R.O.C. .,School of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
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Wang W, Zhang LS, Zinsmaier AK, Patterson G, Leptich EJ, Shoemaker SL, Yatskievych TA, Gibboni R, Pace E, Luo H, Zhang J, Yang S, Bao S. Neuroinflammation mediates noise-induced synaptic imbalance and tinnitus in rodent models. PLoS Biol 2019; 17:e3000307. [PMID: 31211773 PMCID: PMC6581239 DOI: 10.1371/journal.pbio.3000307] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
Hearing loss is a major risk factor for tinnitus, hyperacusis, and central auditory processing disorder. Although recent studies indicate that hearing loss causes neuroinflammation in the auditory pathway, the mechanisms underlying hearing loss–related pathologies are still poorly understood. We examined neuroinflammation in the auditory cortex following noise-induced hearing loss (NIHL) and its role in tinnitus in rodent models. Our results indicate that NIHL is associated with elevated expression of proinflammatory cytokines and microglial activation—two defining features of neuroinflammatory responses—in the primary auditory cortex (AI). Genetic knockout of tumor necrosis factor alpha (TNF-α) or pharmacologically blocking TNF-α expression prevented neuroinflammation and ameliorated the behavioral phenotype associated with tinnitus in mice with NIHL. Conversely, infusion of TNF-α into AI resulted in behavioral signs of tinnitus in both wild-type and TNF-α knockout mice with normal hearing. Pharmacological depletion of microglia also prevented tinnitus in mice with NIHL. At the synaptic level, the frequency of miniature excitatory synaptic currents (mEPSCs) increased and that of miniature inhibitory synaptic currents (mIPSCs) decreased in AI pyramidal neurons in animals with NIHL. This excitatory-to-inhibitory synaptic imbalance was completely prevented by pharmacological blockade of TNF-α expression. These results implicate neuroinflammation as a therapeutic target for treating tinnitus and other hearing loss–related disorders. Prolonged exposure to loud noises causes neuronal hyperexcitability and increases the risk of tinnitus. This study reveals that this type of tinnitus is mediated by noise-induced neuroinflammation; blockade of neuroinflammatory responses prevents noise-induced neuronal excitation/inhibition imbalance and tinnitus.
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Affiliation(s)
- Weihua Wang
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
| | - Li. S. Zhang
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, United States of America
| | - Alexander K. Zinsmaier
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
| | - Genevieve Patterson
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
| | - Emily Jean Leptich
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
| | - Savannah L. Shoemaker
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
| | - Tatiana A. Yatskievych
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
| | - Robert Gibboni
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, United States of America
| | - Edward Pace
- Department of Otolaryngology, Wayne State University, Detroit, Michigan, United States of America
| | - Hao Luo
- Department of Otolaryngology, Wayne State University, Detroit, Michigan, United States of America
| | - Jinsheng Zhang
- Department of Otolaryngology, Wayne State University, Detroit, Michigan, United States of America
- Department of Communication Sciences and Disorders, Wayne State University, Detroit, Michigan, United States of America
| | - Sungchil Yang
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, United States of America
- Department of Biomedical Science, City University of Hong Kong, Kowloon, Hong Kong
| | - Shaowen Bao
- Department of Physiology, University of Arizona, Tucson, Arizona, United States of America
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, United States of America
- * E-mail:
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Huang YS, Koo M, Chen JC, Hwang JH. The association between tinnitus and the risk of ischemic cerebrovascular disease in young and middle-aged patients: A secondary case-control analysis of a nationwide, population-based health claims database. PLoS One 2017; 12:e0187474. [PMID: 29095920 PMCID: PMC5667787 DOI: 10.1371/journal.pone.0187474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/20/2017] [Indexed: 11/20/2022] Open
Abstract
Background Tinnitus and ischemic cerebrovascular disease (ICVD) may share common pathophysiologic mechanisms. Nevertheless, no studies have investigated whether tinnitus is associated with a higher risk of ICVD. The aim of this study was to evaluate the risk of ICVD among young and middle-aged patients with tinnitus. Methods Using the Taiwan’s National Health Insurance Research Database, we identified 3,474 patients 20–45 years old with incident ICVD diagnosed between January 1, 2000 and December 31, 2010 and 17,370 controls, frequency matched on age interval, sex, and year of the index date. Risk of ICVD associated with tinnitus was assessed using multiple logistic regression analyses. Results Tinnitus was significantly associated with a higher risk of incident ICVD among young and middle-aged patients (adjusted odds ratio [OR] 1.66, 95% confidence interval [CI] 1.34–2.04), adjusting for sex, age, and comorbidities. In addition, sex-stratified analysis showed that the associations were significant in both male (adjusted OR 1.55, 95% CI 1.16–2.07) and female patients (adjusted OR 1.77, 95% CI 1.30–2.41). Furthermore, tinnitus was significantly associated with a higher risk of ICVD in the 20.0–29.9 years (adjusted OR 4.11, 95% CI 1.98–8.52) and 30.0–39.9 years (adjusted OR 2.19, 95% CI 1.57–3.05) age groups, but not in the 40.0–45.0 years age group. Conclusions Tinnitus could be a novel risk factor or clinical indicator for young ischemic stroke, and further investigations are warranted.
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Affiliation(s)
- Yung-Sung Huang
- Department of Neurology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Malcolm Koo
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jin-Cherng Chen
- Department of Neurosurgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Juen-Haur Hwang
- School of Medicine, Tzu Chi University, Hualien City, Taiwan
- Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- * E-mail:
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