Identifying non‐otologic risk factors for tinnitus: A systematic review

Abstract

Background The origin of tinnitus has been attributed to a peripheral auditory lesion, inducing bottom‐up changes and resulting in the perception of a “phantom sound.” However, non‐auditory factors can co‐exist as well, and can even lie at the origin of tinnitus development. An increasing body of literature focuses on psychological, (neuro)muscular, cardiovascular and many other influences and their respective associations with tinnitus prevalence. Objective of review The purpose of this study was to provide a comprehensive description of these non‐otologic risk factors, and to summarise the evidence in literature about their link with tinnitus. Type of review A narrative systematic review was conducted, following the Preferred Reporting Items for Systematic reviews and Meta‐Analyses statement. Search strategy The MEDLINE, Embase and Web of Science databases were systematically searched for eligible articles, supplemented with manual search methods and grey literature search. Epidemiological studies reporting on the relationship between various non‐otologic risk factors and tinnitus were included. Evaluation method Quality assessment was performed using the Hoy & Brooks tool. Results Fifty‐five studies were included. Studies were of variable quality, with poor tinnitus definitions and evaluations or questionable sampling of the study population as main contributing factors for high risk of bias. Multiple associated factors have been identified, including cardiovascular, psychological, neurological, musculoskeletal and dietary factors. Conclusions The current literature review identified multiple risk factors that could be of significant importance for tinnitus development, maintenance or aggravation. While causality remains uncertain, this systematic elaboration of possible tinnitus comorbidities/risk factors can help provide direction for future research, and can direct clinicians to identify patients at risk and treat relevant symptoms accordingly.

The Prevalence of Different Types of Headache in Patients with Subjective Tinnitus and Its Influence on Tinnitus Parameters: A Prospective Clinical Study

“…Tinnitus and headache are two very prevalent conditions in the general population [1][2][3][4]. Nevertheless, a link between those two disorders exists as headache was found to be more common in tinnitus patients than in the general population and tinnitus is more likely to be reported in patients with headache compared to the general population [5][6][7][8][9]. Tinnitus is the sensation of hearing a sound with no external auditory stimulus present, affecting up to 15% of the general population, diminishing quality of life, and placing a considerable burden on society due to financial repercussions of treatment cost [3,10].…”

Patients with tinnitus use more primary healthcare compared to people without tinnitus

“…This is not surprising considering the fact that psychological problems such as anxiety, depression or sleep- and concentration difficulties are common comorbidities of tinnitus 30 . An increase in musculoskeletal problems in tinnitus patients might be explained by commonly described comorbidities such as temporomandibular dysfunction (TMD) 17 , 31 . In a systematic review from 2019 the prevalence of tinnitus in patients with temporomandibular dysfunction ranged between 3.7 and 70% 32 .…”

“…Cardiovascular diseases, such as high blood pressure have been described to be associated with tinnitus. Cardiovascular diseases are believed to damage inner ear circulation, and consequently cause tinnitus 17 , 33 .…”

“…In a recent systematic review including 55 studies, multiple significant associations between non-otological risk factors and tinnitus presence were described. These included psychological factors, demographics, musculoskeletal and cardiovascular factors 17 .…”

What Tinnitus Therapy Outcome Measures Are Important for Patients?– A Discrete Choice Experiment

“…Tinnitus is a heterogeneous condition due to differences in experienced distress, localization and nature of the sound. Also, many different comorbidities are associated with tinnitus, such as anxiety, depression, and sleep- or concentration problems ( 1 , 4 , 5 ). Tinnitus might also have a negative influence on quality of life.…”