The Blue Mountains Hearing Study (BMHS) has shown that tinnitus affects one in three older Australians with 16% of cases describing severe annoyance. Among persons describing severe symptoms, 52% have sought professional help. We aim to identify factors associated with the severity of tinnitus in 2,015 persons aged over 54 years. Comprehensive questionnaires about hearing were administered. Air- (250-8000 Hz) and bone-conduction (500-4000 Hz) audiometric thresholds of both ears, together with transient evoked and spontaneous otoacoustic emissions, were measured. Factors predicting severity of tinnitus were assessed in Cox proportional hazard models. After multivariate adjustment, factors significantly associated with severe tinnitus were hearing loss (relative risk [RR] 2.9), dizziness (RR 2.0), head injury (RR 2.0), sinus and middle ear infections (RR 1.9), and mastoiditis (RR 3.9). Associations with mild tinnitus included age (RR 0.8), hearing loss (RR 1.4) and history of dizziness (RR 1.5), meningitis (RR 2.2), and migraine (RR 1.5). Knowledge of these factors could contribute to improved tinnitus management.

The theoretical procedure provides a good initial prescription of three frequency average SSPL, but it is still essential to evaluate the fitting and, if necessary, fine tune the individual's hearing aid. Compression limiting hearing aids can have slightly lower SSPL settings than peak clipping hearing aids for the same acceptability.

Prompted by a recent paper in this journal (Snik et al., 1995), this communication compares the gain and frequency response preferred by a group of 21 severely and profoundly hearing-impaired children (37 test ears) to the NAL-RP and the DSL 3.0 hearing aid prescriptions. The results support the findings of Snik et al. (1995) that the NAL-RP procedure provides an adequate prescription of amplification on average. The individual discrepancies between prescribed and preferred characteristics imply that fine-tuning with an evaluation tool is necessary for some children. It is uncertain whether previous listening experience affects listeners' preferences, and it is suggested that further studies be carried out to address this issue.

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