Testing & Monitoring

The tinnitus population is massive and largely uninformed about treatment options—which includes significant benefit from properly fit hearing aids. The size of the tinnitus population in the United States is nearly 30 million people—or about 10% of the entire population—and the incidence of tinnitus is as high as 26.7% for people ages 65-84 years. Data in this article also confirm that the provision of hearing aids offers substantial benefit to a significant number of people suffering from tinnitus. Evidence suggests that this information should be more widely disseminated in the audiological and medical communities. Sergei Kochkin, PhD, is executive director of the Better Hearing Institute, Washington, DC. Richard Tyler, PhD, is professor in both the Department of Otolaryngology-Head & Neck Surgery and the Department of Communication Sciences and Disorders at the University of Iowa in Iowa City. He has authored numerous articles on the subject of tinnitus, and edited three books on the topic, the two most recent being Tinnitus Treatment: Clinical Protocols (Thieme) and The Consumer Handbook on Tinnitus (Auricle Ink Publishers). Jennifer Born is director of public affairs at the American Tinnitus Association (ATA), Portland, Ore, and also editor of ATA’s magazine, Tinnitus Today. A number of estimates have been provided on the prevalence of tinnitus in the United States. Davis and El Refiae1 estimated that 10% to 15% of the US population experiences chronic or persistent tinnitus (eg, ringing in the ears or internal head noises). About half of the people with tinnitus are bothered by it, and it is reported that about 1% indicate that tinnitus substantially affects their lives. A recent self-report survey using the 1999-2004 National Health and Nutrition Examination Surveys (NHANES)2 database on more than 14,000 subjects estimated that 50 million US adults reported having any tinnitus and 16 million reported frequent tinnitus in the past year. Tinnitus was shown to increase with age, peaking at 14.3% of people ages 60 to 69 years. In addition, it was most prevalent among people with low-to-mid or high frequency hearing loss. Other authors indicate that chronic tinnitus affects 42 million Americans and is considered “clinically significant” in 10 million adults.3,4 It should be acknowledged that differences in the specific questions asked in these surveys likely account for much of the variability in numbers. Tinnitus has been shown to have a direct impact on a person’s emotional well-being, hearing, and ability to sleep and to concentrate—in turn influencing basic life functions, such as socialization and relaxation.5,6 In severe cases, it can interfere with the individual’s ability to perform adequately on the job or contribute to psychological disorders, such as depression, suicide ideation, post-traumatic stress disorder, anxiety, and anger. The constancy of tinnitus and the perceived lack of control can provoke fear, which exacerbates the problem leading to an ever-increasing cycle of distress in the person suffering from tinnitus.7 Only a small number of people contact their physicians or hearing care professionals for help with their tinnitus. The reason perhaps lies in the widespread belief that tinnitus is incurable or untreatable. Yet, there are several methods for treating tinnitus that can alleviate the impact it has on the patient’s quality of life.6,8,9 In a large-scale study by the Better Hearing Institute (BHI), it was shown that 39% of people (more than 9 million adult Americans) indicated they had not sought help for their hearing loss specifically because they concurrently had tinnitus.10 It is likely their belief that tinnitus could not be treated influenced their decision not to seek treatment for either. Thus, those with both untreated tinnitus and untreated hearing loss would be expected to suffer an even greater diminished quality of life than individuals with just tinnitus or just hearing loss. Tinnitus as a Professional Challenge. Since a substantial number of people with both tinnitus and hearing loss choose not to seek a solution for their hearing loss due to their tinnitus, we believe hearing care professionals must provide evidence that they can provide effective treatment for tinnitus. Most people with tinnitus also have a hearing loss. For those with hearing loss, hearing aids should obviously improve their hearing and communication. Hearing aids can help relieve tinnitus symptoms by improving communication, thereby reducing stress and making it easier to accept or cope with tinnitus. Additionally, by amplifying background sound or producing background ambient noise, the loudness or prominence of tinnitus can be reduced. Hearing aids might be viewed as Gestalt therapy for the ears, since tinnitus (previously conspicuously in the foreground) is relegated appropriately to the background when environmental sounds are amplified. The very act of taking the focus off of tinnitus means relief for many people. In a survey of 230 hearing care professionals, we specifically asked them to estimate the impact that using hearing aids had on their patients’ tinnitus.11 Their estimates were encouraging for those with tinnitus: 60% of their patients reported some relief of their tinnitus when using hearing aids, and 20% actually reported major relief of their tinnitus when using hearing aids. Objective. The purpose of this paper is to determine the prevalence of tinnitus in a nationally representative sample of more than 46,000 households—the largest survey of its kind. We focused on quantifying tinnitus among people with hearing impairment, as well as those not reporting hearing impairment. This paper also explores, from the consumers’ perspective, the duration and intensity of their tinnitus and the impact it has on their quality of life. Furthermore, it examines treatment modalities designed to alleviate tinnitus and consumer perceptions of the efficacy of these treatments. Survey Method. The Better Hearing Institute conducts a hearing health survey (MarkeTrak) of 80,000 households every 4 years using the National Family Opinion (NFO) panel. Typically, the survey focuses on people with hearing loss with detailed analysis of consumer experiences with hearing aids and supplemental analysis of hearing-impaired subjects not using hearing aids. In our 2008 survey, we specifically included questions about tinnitus. In November and December 2008, a short screening survey was mailed to 80,000 members of the NFO panel. The panel consists of households that are balanced to the latest US census information with respect to market size, age of household, size of household, and income within each of the nine census regions, as well as by family versus non-family households, state (with the exception of Hawaii and Alaska), and the nation’s top-25 metropolitan statistical areas. In addition to questions previously asked and pertinent to other publications in the 2008 MarkeTrak series, we asked the panel head to indicate: Whether the household had one or more people “with a hearing difficulty in one or both ears without the use of a hearing aid”; Whether the household had one or more people who were the owner of a hearing aid; Whether the household had one or more people with tinnitus. For each question, the panel head checked off “none,” “self,” “spouse,” “other adult,” “child,” “dependent age 18 or over.” This short screening survey was completed by 46,843 households. The response rate to the screening survey was 59%. In January 2009, an extensive 7-page legal size survey was sent to the total universe of hearing aid owners (3,789) in the panel database; 3,174 completed surveys were returned representing an 84% response rate. In February 2009, an extensive 7-page legal survey was sent to a random sample of 5,500 people with hearing loss who had not yet adopted hearing aids (non-adopters). The response rate for the non-adopter survey was 79%. Both hearing aid owners and non-adopters were given a $1 incentive to complete and return their surveys. Due to budgetary constraints, no detailed survey was sent to households where an individual was reported to have tinnitus but not hearing loss (because people with tinnitus typically have an accompanying hearing loss, it is likely this group had a mild hearing loss or a hearing loss outside of the range of normal audiometric testing, in additional to their tinnitus). Both hearing aid owners and hearing-impaired non-adopters were asked the following questions: Whether they were aware of tinnitus (defined as ringing or other sounds perceived in their ears or head). On a 0% to 100% scale, the duration of tinnitus in a day, loudness (0=faint, 100=very loud), and annoyance (0=not annoying at all, 100=extremely annoying or disabling). Areas of life negatively affected by tinnitus (7 areas). Treatments tried for tinnitus (9 treatments). Efficacy of tinnitus treatments on 0-100% scale (0=not effective at all, 100=completely effective). For hearing aid owners, we asked them: To rate the impact of hearing aids on their tinnitus on a 5-point scale: 1=made tinnitus worse, 2=no effect, 3=mild reduction in loudness or awareness, 4=moderate reduction in loudness or awareness, 5) significant reduction in loudness or awareness. If hearing aid owners indicated a mild, moderate, or significant reduction to their tinnitus using hearing aids, we asked them to tell us how often they experienced this reduction: 1=occasionally, 2=frequently, 3=most of the time, 4=all of the time while wearing hearing aid, 5=all of the time even when not wearing their hearing aid. The data presented in this article refer only to households as defined by the US Bureau of Census; that is, people living in a single-family home, duplex, apartment, condominium, mobile home, etc. People living in institutions have not been surveyed; these would include residents of nursing homes, retirement homes, mental...

Category: Testing & Monitoring

Testing & Monitoring

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