E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
A retrospective cross-sectional study on tinnitus prevalence and disease associations in the Dutch population-based cohort Lifelines.
Schubert, Nick M A, Rosmalen, Judith G M, van Dijk, Pim et al. · Hearing research · 2021 · DOI
Quick Summary
This study looked at how common tinnitus (ringing in the ears) is in a large group of Dutch adults and found that about one-third experience it at some point. The researchers discovered that tinnitus is linked to various conditions including hearing problems, heart issues, depression, and notably, chronic fatigue syndrome (ME/CFS). Understanding these connections may help doctors better treat tinnitus and related conditions.
Why It Matters
This large population study identifies chronic fatigue syndrome as a novel disease associate with tinnitus, suggesting shared biological mechanisms between ME/CFS and this common auditory symptom. For ME/CFS patients experiencing tinnitus, this work provides epidemiological evidence that their symptom cluster is recognizable in the general population and warrants investigation of common underlying pathways. The identification of inflammatory and autoimmune disease associations strengthens the biological rationale for investigating immune mechanisms in both conditions.
Observed Findings
31.8% of 124,609 participants reported any tinnitus, and 6.4% reported constant tinnitus
Hearing problems showed the strongest association with constant tinnitus (OR 8.570)
Chronic fatigue syndrome was associated with constant tinnitus (OR 1.568)
Inflammatory conditions (rheumatoid arthritis OR 1.297, ulcerative colitis OR 1.588) and thyroid disease medication use (OR 1.298) were associated with constant tinnitus
Psychiatric disorders including major depressive disorder (OR 1.506) were associated with constant tinnitus
Inferred Conclusions
Tinnitus shares disease associations with functional somatic syndromes, inflammatory diseases, and thyroid dysfunction, suggesting common biological mechanisms may underlie these conditions.
Established risk factors (hearing loss, cardiac arrhythmia, depression) were validated in this large general population cohort.
Future mechanistic research is needed to determine whether tinnitus and associated disorders share common pathophysiological pathways.
Multi-system involvement in tinnitus etiology extends beyond otologic causes to include metabolic, inflammatory, and psychiatric domains.
Remaining Questions
What are the shared biological mechanisms between chronic fatigue syndrome and tinnitus?
What This Study Does Not Prove
This cross-sectional study cannot establish causality or determine whether ME/CFS causes tinnitus, tinnitus causes ME/CFS, or whether a third factor causes both. The study relies on self-reported tinnitus and historical disease data rather than objective audiological testing or prospective follow-up, limiting confidence in temporal relationships. The associations identified do not explain the mechanisms linking these conditions or whether interventions targeting one condition would benefit the other.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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