Tinnitus Among Patients With Anxiety Disorder: A Nationwide Longitudinal Study

Abstract

Objectives: The association between tinnitus and anxiety disorder remains debated. We used a retrospective cohort study to investigate the relationship between anxiety disorder and tinnitus, aiming to decipher possible risk factors for tinnitus in patients with anxiety disorder. Method: Data on a total of 7,525 patients with anxiety disorder and 15,050 patients without (comparison cohort) were extracted from the Longitudinal Health Insurance Database 2005 in Taiwan. The Kaplan-Meier estimator with the log rank test and the Cox proportional-hazard regression model were used to compare the incidence of tinnitus in both groups and to identify risk factors that predicted tinnitus. Results: After adjusting for related covariates, the hazard ratio for the development of tinnitus during the follow-up period was 3.54 (95% confidence interval: 3.11-4.02, P < .001) for anxiety disorder cohort relative to comparison cohort. Age ≧ 60 years, female sex, hypertension, and hyperlipidemia were statistically significant predictive risk factors of tinnitus in patients with anxiety disorder. Conclusion: A significant increase in the lifetime incidence of tinnitus was exhibited in patients with anxiety disorder. Elderly subjects, female sex, hypertension, and hyperlipidemia were risk factors. Clinicians should be alert to the possibility of tinnitus in subjects with anxiety disorder.

The incidence of anxiety in patients with chronic subjective tinnitus

“…These correlations have been reported in other studies [22]. Furthermore, there are many cross-sectional studies in the literature that have explained the association between tinnitus and anxiety disorders, but also one longitudinal study by Sheue-Jane Hou et al [15]. They assessed the incidence of tinnitus in patients with and without the presence of anxiety and, through several explanations, indicated a positive correlation between tinnitus and mental disorders.…”

“…Reasons for this are thought to be numerous, including study design, sample size, socio-demographic characteristics, ethnicity, work environment, short-term exposure to noise, stress, being a soldier, systemic and metabolic diseases like osteoarthritis, thyroid disease, rheumatoid arthritis, hyperlipidemia etc. [15,16]. On the other hand, in terms of level of hearing impairment, statistically significant difference has been found.…”

“…In addition, dysfunction of the central nervous system or genetic factors results in both diseases. This means that the hypothalamus, the limbic system, the locus coreuleus, the dorsal cochlear nucleus and the hypothalamic-pituitary-adrenal axis, as structures which are not under the control of our consciousness, are thought to be important parts of puzzle involved in the pathogenetic mechanisms of anxiety and tinnitus [1,15].…”

“…They are divided into three categories: physical symptoms (16 items), anxious thoughts (11 items) and anxious feelings (6 items) [13]. The results of this questionnaire numerically show the general anxiety symptoms with which we assess the severity of anxiety (minimal, borderline, mild, moderate, severe and extreme anxiety), but also the success of treatment [14,15].…”

Quality of Life and Psychological Distress in Portuguese Older Individuals with Tinnitus

“…Anxiety is the principal psychological symptom in 28% of tinnitus patients with high predictive value for the development of tinnitus-related psychological distress [ 44 , 45 , 46 ]. The Anxiety Scale evaluated in BSI is described signs such as nervousness and tension, feelings of apprehension, fearful feelings, feeling tense and keyed up, some somatic manifestations, often with panic attacks [ 41 ].…”