Identifying Psychological and Clinical Risk Factors for Moderate-to-Severe Tinnitus in Older Patients With Hearing Loss: A Multivariable Prediction Model

Chenguang Zhang¹Yicong Wang¹Chunlong Zhao¹Rou Xue¹Chenghao Hu²Bin Guo^2*

• ¹School of Clinical Medicine, Qinghai University, Xining, China
• ²Department of Otolaryngology, Qinghai University Affiliated Hospital, Xining, China

Objective: To develop and validate a clinical prediction model for moderate-to-severe tinnitus (THI ≥ 38) in patients with hearing loss and to identify the key psychological and clinical factors associated with its risk. Methods: This retrospective single-centre study included 301 patients with hearing loss who visited Qinghai University Affiliated Hospital between August 2024 and May 2025. The cohort was randomly divided into a training set (n = 210) and a validation set (n = 91) in a 7:3 ratio. Moderate-to-severe tinnitus served as the outcome of interest. Psychological and clinical risk factors were initially screened using univariate logistic regression, and variables with P < 0.05 were subsequently included in a multivariable logistic regression model. Results: The final multivariable model identified five independent psychological and clinical risk factors for moderate-to-severe tinnitus: older age (OR = 2.415), hypertension (OR = 2.120), poor sleep quality (OR = 2.821), anxiety (OR = 1.967), and severe hearing loss (OR = 3.452). The model demonstrated good discriminative performance, with an AUC of 0.734 in the training set and 0.760 in the validation set. Conclusion: In patients with hearing loss, psychological and clinical risk factors—including poor sleep quality, anxiety, hypertension, and severe hearing loss—were significantly associated with moderate-to-severe tinnitus. These findings underscore the need for integrated management strategies that address both psychological and clinical components of tinnitus risk.