Bhatt Jay M, Lin Harrison W, Bhattacharyya Neil
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine.
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
JAMA Otolaryngol Head Neck Surg. 2016 Oct 1;142(10):959-965. doi: 10.1001/jamaoto.2016.1700.
Tinnitus is a common problem for millions of individuals and can cause substantial negative effects on their quality of life. A large epidemiologic study of tinnitus and its management patterns in the US adult population is lacking.
To quantify the epidemiologic features and effect of tinnitus and to analyze the management of tinnitus in the United States relative to the 2014 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines.
DESIGN, METHODS, AND PARTICIPANTS: This cross-sectional analysis of the representative 2007 National Health Interview Survey (raw data, 75 764 respondents) identified a weighted national sample of adults (age, ≥18 years) who reported tinnitus in the preceding 12 months. Data were collected in November 2014 at the University of California, Irvine, and Harvard Medical School.
In addition to quantifying prevalence, severity, duration, and regularity of tinnitus, specific data regarding noise exposure and tinnitus management patterns during health care visits were analyzed.
Among an estimated (SE) 222.1 (3.4) million US adults, 21.4 (3.4) million (9.6% [0.3%]) experienced tinnitus in the past 12 months. Among those who reported tinnitus, 27% had symptoms for longer than 15 years, and 36% had nearly constant symptoms. Higher rates of tinnitus were reported in those with consistent exposure to loud noises at work (odds ratio, 3.3; 95% CI, 2.9-3.7) and during recreational time (odds ratio, 2.6; 95% CI, 2.3-2.9). Years of work-related noise exposure correlated with increasing prevalence of tinnitus (r = 0.13; 95% CI, 0.10-0.16). In terms of subjective severity, 7.2% reported their tinnitus as a big or a very big problem compared with 41.6% who reported it as a small problem. Only 49.4% had discussed their tinnitus with a physician, and medications were the most frequently discussed recommendation (45.4%). Other interventions, such as hearing aids (9.2%), wearable (2.6%) and nonwearable (2.3%) masking devices, and cognitive behavioral therapy (0.2%), were less frequently discussed.
The prevalence of tinnitus in the United States is approximately 1 in 10 adults. Durations of occupational and leisure time noise exposures correlated with rates of tinnitus and are likely targetable risk factors. Management options suggested by the recently published AAO-HNSF guidelines were followed infrequently.
耳鸣是数百万人面临的常见问题,会对他们的生活质量产生重大负面影响。美国缺乏针对成年人群体耳鸣及其管理模式的大型流行病学研究。
量化耳鸣的流行病学特征和影响,并根据2014年美国耳鼻咽喉-头颈外科学会基金会(AAO-HNSF)临床实践指南分析美国耳鸣的管理情况。
设计、方法和参与者:对具有代表性的2007年国家健康访谈调查(原始数据,75764名受访者)进行横断面分析,确定了一个加权的全国成年样本(年龄≥18岁),这些成年人在过去12个月内报告有耳鸣症状。数据于2014年11月在加利福尼亚大学欧文分校和哈佛医学院收集。
除了量化耳鸣的患病率、严重程度、持续时间和规律性外,还分析了有关噪声暴露以及就医期间耳鸣管理模式的具体数据。
在美国估计(标准误)2.221亿(340万)成年人中,有2140万(340万)(9.6%[0.3%])在过去12个月内经历过耳鸣。在报告有耳鸣的人群中,27%的人症状持续超过15年,36%的人症状几乎持续存在。在工作中持续暴露于高强度噪声(优势比,3.3;95%置信区间,2.9 - 3.7)以及在休闲时间(优势比,2.6;95%置信区间,2.3 - 2.9)的人群中,耳鸣发生率更高。与工作相关的噪声暴露年限与耳鸣患病率增加相关(r = 0.13;95%置信区间,0.10 - 0.16)。就主观严重程度而言,7.2%的人将耳鸣视为大问题或非常大的问题,而41.6%的人将其视为小问题。只有49.4%的人曾与医生讨论过耳鸣问题,药物是讨论最多的建议(45.4%)。其他干预措施,如助听器(9.2%)、可穿戴(戴在身上的)(2.6%)和不可穿戴(非戴在身上的)掩蔽装置(2.3%)以及认知行为疗法(0.2%),讨论较少。
美国耳鸣患病率约为十分之一成年人。职业和休闲时间的噪声暴露时长与耳鸣发生率相关,可能是可针对的风险因素。最近发布的AAO-HNSF指南所建议的管理方案很少被遵循。