Prevalence of Tinnitus and Association with Self-Rated Health among Military Personnel Injured on Combat Deployment

Incidence and Risk Factors for Tinnitus Among Military Service Members in the Millennium Cohort Study

PURPOSE

Military personnel may be repeatedly exposed to high-noise environments that may increase tinnitus risk. Previous military research on tinnitus has often utilized small samples of personnel with specific experiences and exposures (e.g., combat deployment), with few examinations leveraging longitudinal data. The purpose of this study was to determine the incidence and associated risk factors for new-onset tinnitus in a large prospective and representative military cohort.

METHOD

This study utilized data from the Millennium Cohort Study, the largest and longest running longitudinal health study of service members and veterans, to ascertain self-reported and medical diagnoses of tinnitus. Multivariable logistic regression was employed to identify factors associated with new-onset tinnitus.

RESULTS

New-onset tinnitus was self-reported by 10.7% (n = 2,527) of participants while 3.5% (n = 511) had a medical record tinnitus diagnosis. Tinnitus risk was associated with multiple characteristics, including active duty service, being a member of the Army or Marine Corps, combat deployment experience, combat specialist occupation, prior history of mild traumatic brain injury, panic/anxiety, posttraumatic stress disorder (PTSD) alone, and PTSD comorbid with depression.

CONCLUSIONS

This may be the first study to determine new-onset tinnitus utilizing both self-reported and medical record data in a large prospective cohort of service members and veterans. Additional prospective studies are needed to corroborate our findings and further describe the temporal relationships of military occupational and mental health characteristics with service-related new-onset tinnitus.

Understanding Tinnitus Clinical Care in the Veterans Health Administration and Department of Defense: Overview of Survey Results

PURPOSE

In 2021, the Veterans Health Administration (VHA) and Department of Defense (DOD) Tinnitus Working Group conducted a survey of DOD and VHA clinicians to evaluate clinical services provided for tinnitus.

METHOD

The online survey included a mix of multiple-choice and open-ended questions. Respondents included VHA and DOD health care providers in audiology, otolaryngology, mental health, and primary care, as well as DOD hearing conservation technicians. Quantitative and qualitative methods were used to analyze the data.

RESULTS

A total of 669 providers responded to this combined survey. Results indicated that compared to DOD and VHA providers in other fields, audiologists tended to be more confident and more aware of their role in tinnitus management. In terms of confidence and scope of practice, DOD mental health care providers were the group least familiar with tinnitus care. Other results explored herein include barriers to tinnitus care, facilitators for progressive tinnitus management programs, interventions and patient materials offered, new patient materials wanted, and respondents' preferred information sources and training methods.

CONCLUSION

Survey results indicated that more directed education and support are needed to increase DOD and VHA clinicians' awareness of the need for tinnitus services and their roles in providing that care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27229215.

Relationships between vestibular issues, noise sensitivity, anxiety and prolonged recovery from mild traumatic brain injury among adults: a scoping review

BACKGROUND

We investigated the extent of literature and findings on relationships between vestibular issues, noise sensitivity (NS), and anxiety. We were interested in how relationships among these factors impacted adults' recovery three months or more after mild traumatic brain injury (mTBI).

METHODS

We conducted a scoping review to evaluate the extent of evidence linking relationships between vestibular issues, NS and anxiety with recovery after mTBI. Data relating to study characteristics and key findings were extracted and used to inform a critical narrative synthesis of findings.

RESULTS

After screening and full-text review, we included two studies. Both studies considered the combination of vestibular issues, NS and anxiety and mTBI recovery. Vestibular issues, NS and anxiety were all significantly associated with one another and their presence was the strongest indicator that symptoms would extend beyond three-months after mTBI.

CONCLUSION

Few studies have focused on the relationships that vestibular issues, NS and anxiety have with one another and recovery after mTBI. Given the apparent strong relationships between these factors and prolonged recovery, we highlight this as an area warranting further investigation.

Comprehensive Characterization of Hearing Loss and Tinnitus in Military-Affiliated and Non-Military-Affiliated Individuals

PURPOSE

Military-affiliated individuals (MIs) are at a higher risk of developing hearing loss and tinnitus. While these disorders are well-studied in MIs, their impact relative to non-military-affiliated individuals (non-MIs) remains understudied. Our study compared hearing, speech-in-noise (SIN) perception, and tinnitus characteristics between MIs and non-MIs.

METHOD

MIs (n = 84) and non-MIs (n = 193) underwent hearing threshold assessment and Quick Speech-in-Noise Test. Participants with tinnitus completed psychoacoustic tinnitus matching, numeric rating scale (NRS) for loudness and annoyance, and Tinnitus Functional Index. Comorbid conditions such as anxiety, depression, and hyperacusis were assessed. We used a linear mixed-effects model to compare hearing thresholds and SIN scores between MIs and non-MIs. A multivariate analysis of variance compared tinnitus characteristics between MIs and non-MIs, and a stepwise regression was performed to identify predictors of tinnitus severity.

RESULTS

MIs exhibited better hearing sensitivity than non-MIs; however, their SIN scores were similar. MIs matched their tinnitus loudness to a lower intensity than non-MIs, but their loudness ratings (NRS) were comparable. MIs reported greater tinnitus annoyance and severity on the relaxation subscale, indicating increased difficulty engaging in restful activities. Tinnitus severity was influenced by hyperacusis and depression in both MIs and non-MIs; however, hearing loss uniquely contributed to severity in MIs.

CONCLUSIONS

Our findings suggest that while MIs may exhibit better or comparable listening abilities, they were significantly more affected by tinnitus than non-MIs. Furthermore, our study highlights the importance of assessing tinnitus-related distress across multiple dimensions, facilitating customization of management strategies for both MIs and non-MIs.

Self-Reported Hearing Aid Requirements among U.S. Military Personnel and the Association with Probable Posttraumatic Stress Disorder

BACKGROUND

 Auditory problems are ubiquitous among U.S. military personnel. Hearing aids are an effective treatment for both hearing loss and tinnitus, two of the most common diagnoses among veterans awarded disability compensation, but the prevalence of hearing aid requirements in the U.S. military is unknown. Another military health problem is posttraumatic stress disorder (PTSD), an anxiety disorder characterized by exposure to a traumatic event. While some studies have found an association between auditory problems and PTSD, no research has examined the relationship between hearing aid requirements and PTSD.

PURPOSE

 To identify the prevalence of self-reported hearing aid requirements in U.S. military personnel and examine the association with PTSD.

RESEARCH DESIGN

 Cross-sectional study.

STUDY SAMPLE

 The study population included 104,728 U.S. Navy and Marine Corps service members who completed a Periodic Health Assessment between August and December 2021.

DATA ANALYSIS

 Prevalence of self-reported hearing aid requirements was calculated. A multivariable logistic regression model was used to determine the association between hearing aid requirements and PTSD, while adjusting for covariates.

RESULTS

 Overall, 1.0% (1,088/104,728) of the study population self-reported requiring hearing aids. Hearing aid requirements were positively associated with age, and the highest prevalence was among those aged 40 years and older (3.8%). There was also a statistically higher prevalence among men compared with women (1.2 vs. 0.5%), Marines compared with Navy personnel (1.2 vs. 0.9%), and active duty compared with National Guard/Reserve components (1.1 vs. 0.6%). A significantly higher proportion of service members who required hearing aids screened positive for PTSD than those without hearing aids (30.4 vs. 7.5%). In multivariable regression, those who required a hearing aid, compared with those who did not, had more than three times higher odds of screening positive for PTSD (odds ratio: 3.45; 95% confidence interval: 3.00-3.96).

CONCLUSION

 To our knowledge, this is the first study to report the prevalence of self-reported hearing aid requirements in the U.S. military as well as an association between requiring hearing aids and screening positive for PTSD. Our findings reaffirm the need for interprofessional collaboration between audiologists and psychological health professionals when providing care for these patients.

Relationship Between Tinnitus and Hearing Outcomes Among US Military Personnel After Blast Injury

OBJECTIVES

To examine the association between tinnitus and hearing outcomes among US military personnel after blast injury, including any hearing loss, low-frequency hearing loss, high-frequency hearing loss, early warning shift, and significant threshold shift.

DESIGN

In this retrospective study, the Blast-Related Auditory Injury Database was queried for male military service members who had audiometric data 2 years before and after blast injury between 2004 and 2012 with no history of hearing loss or tinnitus before injury (n = 1693). Tinnitus was defined by diagnostic codes in electronic health records. Multivariable logistic regression examined the association between tinnitus and hearing outcomes, while adjusting for covariates.

RESULTS

Overall, 14.2% (n = 241) of the study sample was diagnosed with tinnitus within 2 years after blast injury. The proportions of all examined hearing outcomes were higher among service members with tinnitus than those without ( p < 0.001). In multivariable analysis, service members with tinnitus had higher adjusted odds of any hearing loss (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.20-2.47), low-frequency hearing loss (OR = 2.77, 95% CI = 1.80-4.26), high-frequency hearing loss (OR = 2.15, 95% CI = 1.47-3.16), early warning shift (OR = 1.83, 95% CI = 1.36-2.45), and significant threshold shift (OR = 2.15, 95% CI = 1.60-2.89) compared with service members without tinnitus.

CONCLUSIONS

The findings of this study demonstrate that tinnitus diagnosed within 2 years after blast injury is associated with the examined hearing outcomes in US military personnel. Service members with blast injury who subsequently experience tinnitus should receive routine audiometric hearing conservation testing and be carefully examined for poor hearing outcomes by an audiologist.

The influence of tinnitus and hearing loss on the functional status of military Service members and Veterans

OBJECTIVE

This study evaluated the influence of tinnitus and hearing loss on the functional status of military Service members and Veterans.

DESIGN

Participants completed audiologic testing and self-report instruments to assess tinnitus, hearing, and general functioning. We conducted multiple linear regression analyses using cross-sectional data with functional status as the dependent variable. The primary independent variables were tinnitus and average low-, high-, and extended high-frequency hearing thresholds. Secondary independent variables were subjective tinnitus severity and hearing difficulties. Each of the independent variables was modelled separately for Service members and Veterans; covariates for each multivariable model were identified a priori and, depending on the association being modelled, included age, gender, blast-wave exposure, and history of military traumatic brain injury.

STUDY SAMPLE

Data were analysed from 283 Service members and 390 Veterans.

RESULTS

After controlling for potential confounders, presence of tinnitus, tinnitus severity, average low-frequency hearing thresholds, and subjective hearing difficulties were significantly associated with functional status in Service members and Veterans.

CONCLUSIONS

These results suggest that tinnitus and poorer low-frequency hearing, and the perceived severity of tinnitus and hearing difficulties, may be associated with poorer functional status among Service members and Veterans.