Tinnitus can be associated with a range of comorbid (existence of two or more) health conditions, including vestibular disorders, audiological problems, and behavioral health issues.
It can be a symptom of a wide range of health issues. It is also a condition that often exists comorbidly with other health maladies.
Below is a list of the health issues most frequently associated with tinnitus, and most often reported as comorbid conditions by tinnitus patients.
The causal relationship between tinnitus and each comorbid condition is variable and complex. In some cases, the comorbid condition is itself the primary cause of tinnitus. This is certainly true with hearing loss and Ménière's disease, in which tinnitus is one of several symptoms caused by the primary disorder. In some situations, tinnitus may exacerbate the comorbid condition, as is the case with hyperacusis. And, in other instances, tinnitus and the comorbid condition have shared causality. This appears to be the case with behavioral health issues, which can be the product of burdensome tinnitus, but also a cause of it.
The following health conditions are commonly associated with tinnitus:
Hearing loss is the primary catalyst for tinnitus symptoms; it is common for patients to experience both conditions simultaneously. The prevalence of comorbid hearing loss and tinnitus fluctuate. Recent research suggests that approximately 90% of tinnitus patients have some degree of hearing loss. Many researchers and clinicians believe that subjective tinnitus cannot exist without some prior loss of hearing — even if such hearing loss is not discernable by the patient.
Sometimes called endolymphatic hydrops, Ménière's disease is a vestibular disorder in the inner ear that can affect hearing and balance. Patients with Ménière's often experience bouts of mild-to-severe vertigo, along with sporadic tinnitus. It is estimated that approximately .02% of the U.S. population (615,000 individuals) has Ménière's.1 About 3% of ATA’s membership reported being diagnosed with the condition.
Hyperacusis is an abnormal, extreme sensitivity to noise, including ordinary environmental sounds presented at a normal volume. Patients with hyperacusis experience physical pain (as opposed to emotional annoyance) when exposed to sound. Estimates for the prevalence of hyperacusis range from 7.7-15% of the population. Approximately 12% of ATA’s members report having hyperacusis.
Also known as selective sound sensitivity, misophonia is an abnormal negative emotional reaction to specific sounds (usually made by other people), such as chewing, sniffling, and clearing one’s throat. Patients with misophonia experience a fight-or-flight response to such sounds, which can trigger anger, disgust, or desire to escape. They may have similar reactions to particular visual stimuli. The prevalence of misophonia in the general population is unknown, but it is estimated that 4-5% of tinnitus patients experience some form of the condition. Less than 1% of ATA’s members self-identified as having misophonia.
Phonophobia is a fearful emotional reaction specific to loud sounds. The prevalence of phonophobia, both within the general population and the tinnitus population, is unknown.
Depression and Anxiety
Mental health issues can be both a contributing factor to burdensome tinnitus and a consequence of burdensome tinnitus. Tinnitus symptoms can generate feelings of despair and anxiety in many patients. Current estimates suggest that 48-78% of patients with severe tinnitus also experience depression, anxiety, or some other behavioral disorder. Approximately 13% of ATA’s membership self-identified as being diagnosed with a mental health issue. At the same time, pre-existing behavioral conditions may make it more likely that the patient will experience tinnitus as a burdensome condition. For example, one large population study posits that people with generalized anxiety disorder are nearly 7 times more likely to experience chronic tinnitus that is burdensome.
Other Vestibular Conditions
The vestibular system, which manages balance and spatial orientation, is closely connected with the auditory system, which controls hearing functions. Several structures in the inner ear play key roles in both sensory systems. As such, damage to one system (as evidenced by tinnitus) is often mirrored by a correlated vestibular condition.