Edited by: Victoria M. Bajo Lorenzana, University of Oxford, United Kingdom
Reviewed by: Paul Smith, University of Otago, New Zealand; Joel I. Berger, University of Iowa, United States
This article was submitted to Auditory Cognitive Neuroscience, a section of the journal Frontiers in Neuroscience
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This study aims to identify gender-specific risk factors associated with the presence of bothersome tinnitus (compared with non-bothersome tinnitus), including sociodemographic and lifestyle factors, tinnitus-associated phenomena (hearing loss, traumatic experiences, sleep disturbances), and physical as well as mental comorbidities.
We conducted a cross-sectional study using survey data from the Swedish LifeGene cohort containing information on self-reported tinnitus (
(1) The majority of factors that differed in frequencies between bothersome and non-bothersome tinnitus were equal for both genders. Women with bothersome tinnitus specifically reported higher rates of cardiovascular disease, thyroid disease, epilepsy, fibromyalgia, and burnout, and men with bothersome tinnitus reported higher rates of alcohol consumption, Ménière’s disease, anxiety syndrome, and panic (compared with non-bothersome tinnitus, respectively). (2) Across both genders, multivariate logistic regression analyses revealed significant associations between bothersome tinnitus and age, reduced hearing ability, hearing-related difficulties in social situations, and reduced sleep quality. In women, bothersome tinnitus was specifically associated with cardiovascular disease and epilepsy; in men, with lower education levels and anxiety syndrome. (3) Moderated logistic regression analyses revealed that the effects of low education and anxiety syndrome were present in men, but not in women, whereas the effects of age, reduced hearing ability and related difficulties, cardiovascular disease, epilepsy, and burnout were not gender specific.
Irrespective of gender, bothersome tinnitus is associated with higher age, reduced hearing ability, hearing-related difficulties, cardiovascular disease, epilepsy, and burnout. Gender-specific effects comprise low levels of education and the presence of anxiety syndrome for men. These findings need to be interpreted with caution, yet they suggest the presence of gender-specific biopsychosocial influences in the emergence or maintenance of bothersome tinnitus. Future studies ought to investigate the underlying mechanisms of the observed relationships.
Tinnitus is a highly prevalent symptom with 10–15% of adults being affected (
Epidemiological research on tinnitus is mixed. While most studies have cross-sectional designs with inherent limitations, a handful of longitudinal studies has contributed to identifying risk factors for tinnitus. The most clearly identified risk factor is hearing loss (
Tinnitus can be associated with a range of physical and mental conditions (
Regarding bothersome tinnitus, relationships with stress were found in cross-sectional studies (
Whether sex or gender impacts on tinnitus severity is poorly understood. For instance, in some studies, women were found to exhibit higher levels of tinnitus-related distress or annoyance (
Given the paucity of research using sex as a biological variable (SABV), the aim of the present study is to investigate gender differences in risk factors for bothersome tinnitus in a large general population sample, covering sociodemographic factors, lifestyle factors, hearing loss, traumatic experiences, sleep disturbances, and physical and mental comorbidities. Logistic regression models are used to identify risk factors within both genders, and moderation models are used to assess whether the effects of the respective factors on bothersome tinnitus are moderated by gender, that is, are different for women and men.
The sample of this study was drawn from the LifeGene cohort. LifeGene is a population-based study conducted in Sweden (
The investigated risk factors were grouped into (1) sociodemographic and lifestyle factors (age, marital status, education level, employment, alcohol use, smoking status, snus and drug use), (2) tinnitus-associated phenomena (hearing ability and hearing-related difficulties in social situations, sleep quality and sleep disturbances, and traumatic/stressful experiences), and (3) physical and (4) mental comorbidities; see
Sociodemographic factors included age, marital status (married, cohabiting, single, separated/divorced, living apart, widowed, same-sex marriage), highest or current level of education (9-year primary school, secondary school, university, other), and employment [employed, unemployed, running an owned or part-owned company, age pension, activity or sickness benefit (early retirement) due to illness/disability, sick leave (for 2 months or longer), parental leave (for 2 months or longer), student, on leave, housewife/man, other]. Lifestyle factors included smoking status and the use of alcohol, snus, and illicit drugs. Alcohol consumption was assessed by the question: “If you consider the last 12 months, how often have you been drinking alcohol?” (“four times a week or more,” “2–3 times per week,” “once a week,” “2–3 times per month,” “once a month or less,” “never”). Smoking status was categorized as “current smoker” (>100 cigarettes in life, at least 1 cigarette/day when smoking most AND currently smoking), “ex-smoker” (>100 cigarettes in life, at least 1 cigarette/day when smoking most, NOT currently smoking), and “non-smoker” (never or occasional: <100 cigarettes in life OR less than 1 cigarette/day when smoking most). The use of snus, a smokeless tobacco product (moist powder) usually placed under the upper lip, was categorized as “current snus user” (>5 boxes in life, 1 box lasting <1 week when using it most AND present use), “ex-user” (>5 boxes in life, 1 box lasting <1 week when using it most, NO present use), “non-user” (never, <5 boxes in life, OR 1 box lasting >1 week when using it most). The use of illicit drugs or unprescribed medication was categorized as “current drug user” (tried more than once AND present use), “ex-user” (tried more than once, NO present use), “non-user” (never OR not more than once) with regard to the following substances: (1) cannabis, marijuana, hash; (2) amphetamine; (3) cocaine; (4) sobril, oxascand, stesolid, diazepam, xanor, alprazolam; (5) stilnoct, zolpidem, imovane, zopiclone; (6) growth hormone; (7) anabolic steroids; (8) codeine, citodon, treo comp, panocod; (9) tramadol, tradolan, tiparol, nobligan; (10) heroin; (11) opium; (12) hallucinogens (psilocybin, psilocin); (13) LSD; (14) ecstasy; (15) GHB; (16) methylphenidate (ritalin, concerta); (17) morphine; (18) subutex, suboxone; or (19) other drug or medication.
Tinnitus-associated phenomena included hearing ability, hearing-related difficulties in social situations, sleep quality, sleep disturbances, and traumatic/stressful experiences. Hearing ability was assessed by the question “How is your hearing?” (“good,” “somewhat reduced,” “very reduced”). Hearing-related difficulties in social situations were assessed by combining the following questions into a mean variable: “Do you have difficulties hearing when speaking to one person in a silent room?,” “Do you have difficulties hearing when speaking to multiple people at the same time?,” “Do you have difficulties hearing when speaking to someone in city traffic?,” “Do you have difficulties hearing where different sounds come from, e.g., cars in traffic?” and “Do you have problems with your hearing and are therefore avoiding meeting people?” (3 = “yes, very difficult,” 2 = “sometimes, a little difficult,” 1 = “no, not at all”). Sleep quality was assessed by the question “How do you sleep usually?” (response scale ranging from 1 = “very bad” to 5 = “very good”; for the analyses, the scale was inverted so that higher values reflect poorer sleep quality). In addition, participants were asked to rate how problematic their sleep disturbances are (“To what degree are sleep disturbances a problem in your life?”), with the response scale ranging from 1 = “no problem at all” to 5 = “a big problem.” Traumatic/stressful life events were assessed by calculating the sum of reported traumatic/stressful life events experienced in childhood or adulthood, see
The following physical comorbidities were selected because of their proposed association with tinnitus in the literature: hypertension, hyperlipidemia, cardiovascular disease (angina, myocardial infarction, or cardiac arrhythmia), asthma, diabetes, thyroid disease, chronic shoulder pain, osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, migraine, Ménière’s disease, epilepsy, multiple sclerosis, and fibromyalgia. The following mental comorbidities were included: burnout, depression, bipolar disease, (generalized) anxiety syndrome, panic, agoraphobia, social anxiety/phobia, obsessive-compulsive disorder, and PTSD. The survey questions assessing these conditions asked for their past or present occurrence.
Statistical analyses were computed with IBM SPSS Statistics (version 25) for Windows 7. The significance level was set to α = 0.05. In the first step, we identified risk factors for bothersome (vs. non-bothersome) tinnitus within each gender: (1) by comparing frequencies and medians of each variable between non-bothersome and bothersome tinnitus for women and men separately and (2) by further analyzing relevant variables [identified in (1)] as predictors of bothersome tinnitus in logistic regression analyses for women and men separately. Lastly, (3) for the comparison between genders, we tested whether gender moderated the effects of each risk factor [identified in (2)] across the whole sample.
(1) Pearson’s
Completeness of the data was high; in total, 1.5% of values were missing. The response rate was lowest with 83.8% on hearing-related difficulties in social situations, followed by 88.3% on employment; other response rates varied between 96.7 and 98.9% on eight variables (marital status, education, alcohol consumption, smoking status, snus use, drug use, hearing ability, traumatic experiences), and between 99.5 and 99.7% on 26 variables (sleep quality, sleep disturbances, and all comorbidities). All data was available for age and gender.
Of the 7615 participants with tinnitus, 697 reported bothersome tinnitus (9.2%). Females represented 56.5% of the sample (4301 participants): 393 with bothersome tinnitus (9.1%). In males (3314 participants), 304 reported bothersome tinnitus (9.2%). Participants were between 11 and 84 years old (
Histogram of non-bothersome and bothersome tinnitus (count data) by age and gender.
Female participants with bothersome tinnitus were significantly older than those with non-bothersome tinnitus,
Female participants: Differences in sociodemographic, lifestyle factors, and tinnitus-associated phenomena between bothersome and non-bothersome tinnitus.
25.7% (971) | −3.0 | 32.6% (126) | 3.0 | |
33.7% (1274) | 2.0 | 28.8% (111) | −2.0 | |
24.3% (918) | 2.4 | 18.9% (73) | −2.4 | |
5.6% (210) | −2.8 | 9.1% (35) | 2.8 | |
Living apart | 10.2% (386) | 0.1 | 10.1% (39) | −0.1 |
Widowed | 0.5% (20) | 0.0 | 0.5% (2) | 0.0 |
Same-sex marriage | 0.1% (2) | 0.5 | 0.0% (0) | −0.5 |
Nine-year primary school | 2.2% (83) | −1.8 | 3.6% (14) | 1.8 |
Secondary school | 23.1% (880) | −0.8 | 24.9% (96) | 0.8 |
66.1% (2516) | 3.4 | 57.5% (222) | −3.4 | |
8.6% (328) | −3.5 | 14.0% (54) | 3.5 | |
60.6% (2069) | 2.4 | 53.9% (192) | −2.4 | |
3.2% (108) | −3.0 | 6.2% (22) | 3.0 | |
Running an owned or part-owned company | 6.6% (225) | 0.9 | 5.3% (19) | −0.9 |
3.0% (103) | −6.0 | 9.3% (33) | 6.0 | |
1.0% (34) | −3.0 | 2.8% (10) | 3.0 | |
Sick leave (for 2 months or longer) | 1.2% (42) | 0.2 | 1.1% (4) | −0.2 |
Parental leave (for 2 months or longer) | 3.6% (123) | 0.2 | 3.4% (12) | −0.2 |
Student | 18.6% (636) | 1.6 | 15.2% (54) | −1.6 |
On leave | 0.1% (3) | 0.6 | 0.0% (0) | −0.6 |
Housewife/man | 0.3% (9) | 1.0 | 0.0% (0) | −1.0 |
Other | 1.9% (64) | −1.2 | 2.8% (10) | 1.2 |
Non-smoker | 60.9% (2321) | 1.4 | 57.3% (220) | −1.4 |
28.7% (1095) | −2.6 | 35.2% (135) | 2.6 | |
Smoker | 10.4% (395) | 1.7 | 7.6% (29) | −1.7 |
70.4% (2663) | 12.1 | 39.8% (150) | −12.1 | |
28.4% (1073) | −9.7 | 52.5% (198) | 9.7 | |
1.2% (44) | −9.2 | 7.7% (29) | 9.2 | |
3908 | 32 | 393 | 40 | |
3245 | 1.4 | 356 | 1.5 | |
3843 | 3 | 388 | 4 | |
3898 | 2 | 393 | 3 | |
3895 | 2 | 393 | 3 |
Male participants with bothersome tinnitus were significantly older than those with non-bothersome tinnitus,
Male participants: Differences in sociodemographic, lifestyle factors, and tinnitus-associated phenomena between bothersome and non-bothersome tinnitus.
23.9% (696) | −5.0 | 37.1% (111) | 5.0 | |
Cohabiting | 36.5% (1063) | 1.5 | 32.1% (96) | −1.5 |
26.6% (776) | 2.8 | 19.1% (57) | −2.8 | |
Separated/divorced | 3.5% (102) | −0.5 | 4.0% (12) | 0.5 |
Living apart | 9.5% (276) | 1.4 | 7.0% (21) | −1.4 |
0.0% (1) | −3.4 | 0.7% (2) | 3.4 | |
Same-sex marriage | 0.0% (1) | 0.3 | 0.0% (0) | −0.3 |
2.7% (80) | −6.1 | 9.3% (28) | 6.1 | |
27.9% (820) | −2.0 | 33.2% (100) | 2.0 | |
61.7% (1815) | 4.8 | 47.5% (143) | −4.8 | |
Other | 7.8% (229) | −1.3 | 10.0% (30) | 1.3 |
Employed | 62.4% (1671) | 1.6 | 57.5% (158) | −1.6 |
Unemployed | 3.2% (86) | −0.1 | 3.3% (9) | 0.1 |
11.4% (305) | −2.1 | 15.6% (43) | 2.1 | |
3.8% (101) | −4.7 | 9.8% (27) | 4.7 | |
Activity or sickness benefit (early retirement) due to illness/disability | 0.4% (11) | −0.8 | 0.7% (2) | 0.8 |
Sick leave (for 2 months or longer) | 0.6% (15) | −0.3 | 0.7% (2) | 0.3 |
Parental leave (for 2 months or longer) | 1.0% (28) | 0.5 | 0.7% (2) | −0.5 |
15.9% (425) | 3.0 | 9.1% (25) | −3.0 | |
On leave | 0.3% (7) | 0.8 | 0.0% (0) | −0.8 |
Housewife/man | 0.0% (1) | 0.3 | 0.0% (0) | −0.3 |
1.1% (29) | −2.1 | 2.5% (7) | 2.1 | |
5.5% (163) | −2.5 | 9.1% (27) | 2.5 | |
2–3 times a week | 26.4% (781) | 0.3 | 25.5% (76) | −0.3 |
Once a week | 21.5% (637) | 1.4 | 18.1% (54) | −1.4 |
2–3 times a month | 26.1% (772) | 1.4 | 22.5% (67) | −1.4 |
Once a month or less | 17.7% (522) | −0.6 | 19.1% (57) | 0.6 |
2.8% (82) | −2.8 | 5.7% (17) | 2.8 | |
64.5% (1903) | 3.5 | 54.2% (162) | −3.5 | |
28.5% (842) | −3.2 | 37.5% (112) | 3.2 | |
Smoker | 7.0% (207) | −0.9 | 8.4% (25) | 0.9 |
66.1% (1966) | 11.8 | 31.4% (94) | −11.8 | |
32.9% (977) | −9.5 | 60.5% (181) | 9.5 | |
1.0% (31) | −9.0 | 8.0% (24) | 9.0 | |
3010 | 33 | 304 | 39.5 | |
2497 | 1.2 | 281 | 1.4 | |
2966 | 3 | 299 | 3 | |
2997 | 2 | 304 | 3 | |
2996 | 2 | 304 | 2 |
Compared with women with non-bothersome tinnitus, women with bothersome tinnitus were more often ex-smokers,
For both women and men, participants with bothersome tinnitus reported more often somewhat reduced or very reduced hearing ability compared with participants with non-bothersome tinnitus [women:
Women with bothersome tinnitus reported higher rates of hypertension,
Differences in physical and mental comorbidities between bothersome and non-bothersome tinnitus.
5.7% (223) | −2.3 | 8.7% (34) | 2.3 | |
2.5% (97) | −3.0 | 5.1% (20) | 3.0 | |
4.2% (165) | −4.4 | 9.2% (36) | 4.4 | |
Asthma | 12.5% (485) | 0.0 | 12.5% (49) | 0.0 |
Diabetes | 0.5% (19) | −1.4 | 1.0% (4) | 1.4 |
5.8% (226) | −3.8 | 10.7% (42) | 3.8 | |
7.2% (282) | −4.8 | 14.0% (55) | 4.8 | |
5.4% (212) | −4.4 | 11.0% (43) | 4.4 | |
Rheumatoid arthritis | 0.8% (30) | 0.0 | 0.8% (3) | 0.0 |
Systemic lupus erythematosus | 0.1% (5) | 0.7 | 0.0% (0) | −0.7 |
Migraine | 19.2% (749) | −1.2 | 21.7% (85) | 1.2 |
Ménière’s disease | 0.2% (8) | −1.2 | 0.5% (2) | 1.2 |
0.7% (26) | −2.9 | 2.0% (8) | 2.9 | |
Multiple sclerosis | 0.1% (5) | 0.7 | 0.0% (0) | −0.7 |
1.3% (50) | −4.3 | 4.1% (16) | 4.3 | |
12.1% (470) | −4.3 | 19.6% (77) | 4.3 | |
25.0% (972) | −2.9 | 31.6% (124) | 2.9 | |
Bipolar disease | 0.7% (29) | −1.6 | 1.5% (6) | 1.6 |
Anxiety syndrome | 12.3% (478) | −1.6 | 15.1% (59) | 1.6 |
Panic | 13.9% (542) | −0.3 | 14.5% (57) | 0.3 |
Agoraphobia | 0.7% (28) | −1.2 | 1.3% (5) | 1.2 |
3.7% (143) | −2.4 | 6.1% (24) | 2.4 | |
Obsessive-compulsive disorder | 2.5% (97) | −0.7 | 3.1% (12) | 0.7 |
Posttraumatic stress disorder | 2.2% (84) | −1.8 | 3.6% (14) | 1.8 |
5.9% (176) | −3.2 | 10.6% (32) | 3.2 | |
3.8% (114) | −3.4 | 7.9% (24) | 3.4 | |
Cardiovascular disease | 3.7% (112) | −1.9 | 5.9% (18) | 1.9 |
Asthma | 9.7% (289) | −0.9 | 11.2% (34) | 0.9 |
Diabetes | 0.7% (22) | 1.5 | 0.0% (0) | −1.5 |
Thyroid disease | 0.8% (25) | −1.4 | 1.7% (5) | 1.4 |
2.8% (85) | −5.0 | 8.3% (25) | 5.0 | |
3.7% (111) | −3.0 | 7.3% (22) | 3.0 | |
Rheumatoid arthritis | 0.3% (9) | −1.0 | 0.7% (2) | 1.0 |
Systemic lupus erythematosus | 0.0% (0) | 0.0 | 0.0% (0) | 0.0 |
Migraine | 8.9% (267) | −0.8 | 10.2% (31) | 0.8 |
0.2% (5) | −4.5 | 1.7% (5) | 4.5 | |
Epilepsy | 0.7% (21) | 0.8 | 0.3% (1) | −0.8 |
Multiple sclerosis | 0.2% (5) | 0.7 | 0.0% (0) | −0.7 |
Fibromyalgia | 0.1% (4) | 0.6 | 0.0% (0) | −0.6 |
Burnout | 7.6% (227) | −1.0 | 9.2% (28) | 1.0 |
14.5% (433) | −2.8 | 20.5% (62) | 2.8 | |
Bipolar disease | 0.8% (23) | 0.9 | 0.3% (1) | −0.9 |
7.0% (210) | −4.1 | 13.5% (41) | 4.1 | |
7.4% (221) | −3.6 | 13.2% (40) | 3.6 | |
Agoraphobia | 0.3% (10) | −0.9 | 0.7% (2) | 0.9 |
2.9% (88) | −3.4 | 6.6% (20) | 3.4 | |
Obsessive-compulsive disorder | 1.4% (43) | −1.2 | 2.3% (7) | 1.2 |
Posttraumatic stress disorder | 0.8% (23) | −1.6 | 1.7% (5) | 1.6 |
Men with bothersome tinnitus reported higher rates of hypertension,
Higher age, level of education (all factor levels non-significant), and employment status (being unemployed, in early retirement due to illness/disability, and student; contrasted with being employed) significantly predicted bothersome tinnitus, Nagelkerke
Female participants: Logistic regression models for sociodemographic and lifestyle factors (Model 1), tinnitus-associated phenomena (Model 2), physical comorbidities (Model 3), and mental comorbidities (Model 4).
Age∗∗∗ | 0.027 | 0.007 | 17.41 | <0.001 | 1.028 | 1.015 | 1.041 |
Marital status | |||||||
Education∗ | 8.92 | 0.030 | |||||
Employment∗ | 22.13 | 0.014 | |||||
Unemployed∗∗ | 0.860 | 0.256 | 11.25 | 0.001 | 2.364 | 1.430 | 3.908 |
Early retirement due to illness/disability∗ | 0.775 | 0.394 | 3.87 | 0.049 | 2.172 | 1.003 | 4.704 |
Student∗ | 0.370 | 0.186 | 3.97 | 0.046 | 1.447 | 1.006 | 2.082 |
Smoking status | |||||||
Hearing ability∗∗∗ | 47.52 | <0.001 | |||||
Somewhat reduced∗∗∗ | 0.853 | 0.133 | 41.38 | <0.001 | 2.347 | 1.810 | 3.043 |
Very reduced∗∗∗ | 1.438 | 0.304 | 22.43 | <0.001 | 4.213 | 2.323 | 7.640 |
Hearing-related difficulties in social situations∗∗∗ | 1.023 | 0.165 | 38.27 | <0.001 | 2.782 | 2.012 | 3.848 |
Traumatic/stressful experiences | |||||||
Poor sleep quality∗∗ | 0.206 | 0.074 | 7.76 | 0.005 | 1.229 | 1.063 | 1.420 |
Problematic sleep disturbances | |||||||
Hypertension | |||||||
Hyperlipidemia | |||||||
Cardiovascular disease∗∗ | 0.658 | 0.198 | 11.09 | 0.001 | 1.931 | 1.311 | 2.844 |
Thyroid disease∗∗ | 0.536 | 0.182 | 8.70 | 0.003 | 1.708 | 1.197 | 2.439 |
Chronic shoulder pain∗∗ | 0.506 | 0.167 | 9.15 | 0.002 | 1.659 | 1.195 | 2.304 |
Osteoarthritis∗∗ | 0.550 | 0.184 | 8.92 | 0.003 | 1.733 | 1.208 | 2.487 |
Epilepsy∗ | 1.041 | 0.415 | 6.31 | 0.012 | 2.833 | 1.257 | 6.383 |
Fibromyalgia∗ | 0.759 | 0.312 | 5.94 | 0.015 | 2.137 | 1.160 | 3.937 |
Burnout∗∗ | 0.488 | 0.148 | 10.94 | 0.001 | 1.629 | 1.220 | 2.176 |
Depression | |||||||
Social anxiety |
Hearing ability (somewhat reduced hearing ability and very reduced hearing ability; contrasted with good hearing), hearing-related difficulties in social situations, and poor sleep quality significantly predicted bothersome tinnitus, Nagelkerke
The past or present occurrence of cardiovascular disease, thyroid disease, chronic shoulder pain, osteoarthritis, epilepsy, and fibromyalgia significantly predicted bothersome tinnitus, Nagelkerke
The past or present occurrence of burnout significantly predicted bothersome tinnitus, Nagelkerke
Higher age and level of education (secondary school, university, and “other”; contrasted with primary school) significantly predicted bothersome tinnitus, Nagelkerke
Male participants: Logistic regression models for sociodemographic and lifestyle factors (Model 1), tinnitus-associated phenomena (Model 2), physical comorbidities (Model 3), and mental comorbidities (Model 4).
Age∗∗∗ | 0.032 | 0.007 | 18.57 | <0.001 | 1.033 | 1.018 | 1.048 |
Marital status | |||||||
Education∗∗∗ | 21.08 | <0.001 | |||||
Secondary school∗∗ | −0.878 | 0.272 | 10.44 | 0.001 | 0.416 | 0.244 | 0.708 |
University∗∗∗ | −1.193 | 0.266 | 20.11 | <0.001 | 0.303 | 0.180 | 0.511 |
Other∗∗ | −0.891 | 0.321 | 7.69 | 0.006 | 0.410 | 0.219 | 0.770 |
Employment | |||||||
Alcohol | |||||||
Smoking status | |||||||
Hearing ability∗∗∗ | 68.13 | <0.001 | |||||
Somewhat reduced∗∗∗ | 1.130 | 0.153 | 54.90 | <0.001 | 3.097 | 2.296 | 4.176 |
Very reduced∗∗∗ | 2.125 | 0.340 | 39.02 | <0.001 | 8.372 | 4.298 | 16.308 |
Hearing-related difficulties in social situations∗∗∗ | 0.799 | 0.207 | 14.93 | <0.001 | 2.224 | 1.483 | 3.336 |
Traumatic/stressful experiences | |||||||
Poor sleep quality∗∗ | 0.226 | 0.085 | 7.01 | 0.008 | 1.253 | 1.060 | 1.481 |
Problematic sleep disturbances | |||||||
Hypertension | |||||||
Hyperlipidemia | |||||||
Chronic shoulder pain∗∗∗ | 0.992 | 0.243 | 16.71 | <0.001 | 2.697 | 1.676 | 4.339 |
Osteoarthritis | |||||||
Ménière’s disease∗∗ | 2.084 | 0.658 | 10.02 | 0.002 | 8.037 | 2.211 | 29.211 |
Depression | |||||||
Anxiety syndrome∗ | 0.449 | 0.224 | 4.00 | 0.045 | 1.566 | 1.009 | 2.430 |
Panic | |||||||
Social anxiety |
Hearing ability (somewhat reduced hearing ability and very reduced hearing ability; contrasted with good hearing), hearing-related difficulties in social situations, and poor sleep quality significantly predicted bothersome tinnitus, Nagelkerke
The past or present occurrence of chronic shoulder pain and Ménière’s disease significantly predicted bothersome tinnitus, Nagelkerke
The past or present occurrence of anxiety syndrome significantly predicted bothersome tinnitus, Nagelkerke
In the final regression analysis, all significant predictors from Models 1 to 4 were included in the same model for multivariable adjustment (for women and men, respectively). For both genders, higher age, somewhat reduced and very reduced hearing ability, hearing-related difficulties in social situations, and poor sleep quality were significant predictors of bothersome tinnitus. Additionally, cardiovascular disease and epilepsy were significant predictors for women, and education and anxiety syndrome for men. Regarding the level of education, secondary school, university, and “other” were associated with a lower risk of bothersome tinnitus compared with primary school. Model summary can be found in
Multivariable adjusted regression model for the prediction of bothersome tinnitus (Model 5).
Age∗ | 0.013 | 0.007 | 3.86 | 0.049 | 1.013 | 1.000 | 1.027 |
Education | |||||||
Employment | |||||||
Self-rated hearing ability∗∗∗ | 38.42 | <0.001 | |||||
Somewhat reduced∗∗∗ | 0.823 | 0.823 | 32.69 | <0.001 | 2.277 | 1.717 | 3.018 |
Very reduced∗∗∗ | 1.431 | 0.319 | 20.12 | <0.001 | 4.182 | 2.238 | 7.815 |
Hearing-related difficulties in social situations∗∗∗ | 0.834 | 0.177 | 22.15 | <0.001 | 2.302 | 1.627 | 3.258 |
Poor sleep quality∗ | 0.122 | 0.060 | 4.08 | 0.043 | 1.129 | 1.004 | 1.271 |
Cardiovascular disease∗ | 0.480 | 0.237 | 4.11 | 0.043 | 1.616 | 1.016 | 2.568 |
Thyroid disease | |||||||
Fibromyalgia | |||||||
Chronic shoulder pain | |||||||
Osteoarthritis | |||||||
Epilepsy∗ | 1.059 | 0.457 | 5.36 | 0.021 | 2.883 | 1.176 | 7.067 |
Burnout | |||||||
Age∗∗ | 0.017 | 0.005 | 11.20 | 0.001 | 1.017 | 1.007 | 1.027 |
Education∗∗ | 16.20 | 0.001 | |||||
Secondary school∗∗ | −0.781 | 0.280 | 7.76 | 0.005 | 0.458 | 0.265 | 0.793 |
University∗∗∗ | −1.059 | 0.271 | 15.23 | <0.001 | 0.347 | 0.204 | 0.590 |
Other∗∗ | −0.899 | 0.329 | 7.46 | 0.006 | 0.407 | 0.214 | 0.776 |
Self-rated hearing ability∗∗∗ | 52.96 | <0.001 | |||||
Somewhat reduced∗∗∗ | 1.053 | 0.156 | 45.32 | <0.001 | 2.865 | 2.109 | 3.893 |
Very reduced∗∗∗ | 1.872 | 0.357 | 27.50 | <0.001 | 6.499 | 3.229 | 13.082 |
Hearing-related difficulties in social situations∗∗ | 0.635 | 0.211 | 9.06 | 0.003 | 1.887 | 1.248 | 2.852 |
Poor sleep quality∗∗∗ | 0.267 | 0.068 | 15.35 | <0.001 | 1.306 | 1.143 | 1.493 |
Chronic shoulder pain | |||||||
Ménière’s disease | |||||||
Anxiety syndrome∗ | 0.464 | 0.216 | 4.62 | 0.032 | 1.590 | 1.042 | 2.427 |
Predictors identified by the logistic regression analysis within men and women (all predictors included in Model 5 for female and/or male participants) were further analyzed to investigate whether gender moderates their effects on bothersome tinnitus, that is, whether their effects on bothersome tinnitus are different for women and men. These analyses revealed main effects (gender-independent) of age, hearing ability, hearing-related difficulties in social situations, cardiovascular disease, epilepsy and burnout; and moderating effects of gender for education and anxiety syndrome, see
Moderation analysis by gender for the prediction of bothersome tinnitus.
Age∗∗ | 0.029 | 0.009 | 0.001 | 1.029 | 1.011 | 1.047 |
Self-rated hearing ability∗∗∗ | 1.039 | 0.220 | <0.001 | 2.828 | 1.837 | 4.351 |
Hearing-related difficulties in social situations∗∗∗ | 1.589 | 0.316 | <0.001 | 4.897 | 2.636 | 9.096 |
Cardiovascular disease∗ | 1.168 | 0.465 | 0.012 | 3.216 | 1.293 | 7.997 |
Epilepsy∗ | 3.020 | 1.310 | 0.021 | 20.481 | 1.571 | 267.040 |
Burnout∗∗ | 0.938 | 0.344 | 0.007 | 2.554 | 1.301 | 5.013 |
Education × Gender∗∗ | −0.393 | 0.125 | 0.002 | 0.675 | 0.528 | 0.863 |
Anxiety syndrome × Gender∗ | 0.494 | 0.236 | 0.036 | 1.638 | 1.032 | 2.601 |
The current study investigated a range of potential risk factors for bothersome tinnitus in a large Swedish sample. Our results indicate that participants with bothersome tinnitus differ from those with non-bothersome tinnitus in several aspects. Higher age, reduced hearing ability, more hearing-related difficulties in social situations, the past or present occurrence of cardiovascular disease, epilepsy, and burnout were associated with bothersome tinnitus in both genders, whereas associations of low education and anxiety syndrome were only present in male participants.
The effects of age and hearing loss on bothersome tinnitus are in accordance with the findings of
Female and male participants with bothersome tinnitus differed from those with non-bothersome tinnitus regarding marital status and employment (in frequency analyses). Being separated, divorced or widowed, and being unemployed, in early retirement, or running an owned or part-owned company might constitute stress factors, which can trigger or increase adverse tinnitus effects (
Lower levels of education and past or present comorbid anxiety syndrome were specifically related to bothersome tinnitus in men. Several studies report links between low education levels and tinnitus (
Comorbidity between tinnitus and anxiety disorders is high, and they might share underlying neurobiological mechanisms (
The medical assessment of tinnitus patients should include screenings for comorbidities, especially cardiovascular disease and epilepsy, which must be considered in clinical management. Anxiety and burnout should also be routinely investigated, as psychological treatments that target cognitive-affective sequelae of bothersome tinnitus have great potential to improve tinnitus burden (
Some limitations must be considered. As the design of this study is cross-sectional, no information on the causality of relationships can be derived. For many factors, the relationships with bothersome tinnitus are most likely complex and bidirectional; for example, anxiety can precede, be caused by, or increase tinnitus-related distress (
In summary, the present study found general associations between bothersome tinnitus and higher age, reduced hearing ability, hearing-related difficulties in social situations, cardiovascular disease, epilepsy, and burnout. In men, low education levels and comorbid anxiety might exert specific influences in the emergence or maintenance of bothersome tinnitus. Yet the effects of low education, in particular, must be interpreted with caution because of possible confounding influences. These new findings obtained from a large general population sample add to the literature of gender differences in tinnitus and imply the need for medical as well as psychological screenings of affected individuals and personalization of clinical treatment pathways. Future studies should investigate the mechanisms behind these general and gender-specific associations with bothersome tinnitus.
The data analyzed in this study is subject to the following licenses/restrictions: Restrictions are based on the Swedish Act (2013:794) requiring that a valid ethical approval is obtained in Sweden. Requests to access these datasets should be directed to NP,
The studies involving human participants were reviewed and approved by the Local Ethics Committee “Regionala etikprövningsnämnden” in Stockholm (2015/2129-31/1). Adult participants provided their written informed consent to participate in this study. For participants under the age of 18, written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.
BM, CC, NP, and BC devised the project. BM, BB, PB, and LB conceived the study. NP provided the data. BB and LB devised the analysis strategy. LB performed the statistical analysis and wrote the first draft of the manuscript. BM, BB, PB, CC, NP, and BC critically reviewed the manuscript. All authors contributed to the article and approved the submitted version.
CC is supported by the UK National Institute for Health Research (NIHR) Biomedical Research Centre but the views expressed herein are his own and do not represent those of NIHR nor the UK Department of Health and Social Care.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The Supplementary Material for this article can be found online at: