The Interrelationship of Tinnitus and Hearing Loss Secondary to Age, Noise Exposure, and Traumatic Brain Injury.
The Interrelationship of Tinnitus and Hearing Loss Secondary to Age, Noise Exposure, and Traumatic Brain Injury.
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年龄、噪音暴露和创伤性脑损伤继发的耳鸣和听力损失的相互关系。
DOI：
10.1097/aud.0000000000001222
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
onbehalfofVAMillionVeteranProgram
中科院分区：
文献类型：
--
作者：
Clifford,RoyceEllen;Ryan,AllenF;
onbehalfofVAMillionVeteranProgram
目的：在过去的15年里，耳鸣一直是退伍军人管理局排名第一的残疾，但其与年龄、噪音创伤和创伤性脑损伤等病因引起的听力损失的相互作用仍然缺乏研究。我们的目的是分析听力损失和耳鸣，包括听力图数据，百万退伍军人计划背景下的军事暴露在老龄化人口。设计：汇总了2011年至2020年百万退伍军人计划中758,005名退伍军人的健康记录、问卷调查、听力图和军事数据，并计算了祖先、性别、听力损失和军事暴露（如战斗、爆炸和服役时期）的相对风险（RR）。然后分析了具有重要人口统计测量和暴露的多变量模型。接下来，通过两种方法对有和没有耳鸣的人按性别分层的听力图数据进行比较：首先，将标准频率下的平均阈值与根据ISO 7029: 2000E年龄和性别公式调整的阈值进行比较。其次，将≤40岁人群与41岁及以上人群的水平进行比较。最后，研究人员检验了比例风险模型，以确定耳鸣和听力损失之间的发病时间，分别计算电子健康记录诊断（ICD）和自我报告。结果：耳鸣自述、诊断或两者皆有，占37.5%(95% CI, 37.4 ~ 37.6)，平均年龄61.5岁（95% CI, 61.4 ~ 61.5），年龄范围18 ~ 112岁。听力损失患者患耳鸣的可能性是听力损失患者的4.15倍（95% CI, 4.12 - 4.15）。非洲裔美国人出现耳鸣的可能性较小（RR 0.61, 95% CI, 0.60 - 0.61），女性也是如此（RR 0.65, 95% CI, 0.64 - 0.65）。多变量模型显示，创伤性脑损伤（95% CI, 1.71 ~ 1.73）和日常战斗噪声暴露（1.17,95% CI, 1.14 ~ 1.17）的RR为1.73，高于年龄（0.998,95% CI, 0.997 ~ 0.998）。与没有耳鸣的退伍军人相比，≤40岁的受试者在所有标准频率下的听力阈值虽小但明显升高，耳鸣对听力阈值的影响随着年龄的增长而减弱。在危险模型中，那些新发耳鸣的bbbb40人比那些更年轻的人更早有听力丧失的风险，发病率也更高。耳鸣后听力丧失率接近100%。相比之下，只有大约50%的最初自我报告听力损失的人有后期听力损失的风险，与ICD相比，那些听力损失的ICD更有可能在随后维持耳鸣的ICD。结论：有证据表明，军队中耳鸣的发生与环境暴露的关系比与年龄的关系更密切。耳鸣影响整个听力图频谱的听力频率的发现表明一种独立于张力性的声学损伤。尤其是男性，耳鸣可能是听力损伤的先兆，预示着以后的听力损失。
Objective:Tinnitus has been the No. 1 disability at the Veteran Administration for the last 15 years, yet its interaction with hearing loss secondary to etiologies such as age, noise trauma, and traumatic brain injuries remains poorly characterized. Our objective was to analyze hearing loss and tinnitus, including audiogram data, of the Million Veteran Program within the context of military exposures in an aging population.Design:Health records, questionnaires, audiograms, and military data were aggregated for 758,005 Veteran participants in the Million Veteran Program 2011 to 2020, with relative risks (RR) calculated for ancestries, sex, hearing loss and military exposures such as combat, blast, and military era served. A multivariate model with significant demographic measures and exposures was then analyzed. Next, audiogram data stratified by sex were compared for those with and without tinnitus by two methods: first, mean thresholds at standard frequencies were compared to thresholds adjusted per ISO 7029: 2000E age and sex formulae. Second, levels for those≤ 40 years of age were compared with those 41 and older. Finally, a proportional hazards model was examined to ascertain the timing between the onset of tinnitus and hearing loss, calculated separately for electronic health record diagnoses (ICD) and self-report.Results:Tinnitus was either self-reported, diagnosed, or both in 37.5%(95% CI, 37.4 to 37.6), mean age 61.5 (95% CI, 61.4 to 61.5), range 18 to 112 years. Those with hearing loss were 4.15 times (95% CI, 4.12 to 4.15) as likely to have tinnitus. Americans of African descent were less likely to manifest tinnitus (RR 0.61, 95% CI, 0.60 to 0.61), as were women (RR 0.65, 95% CI, 0.64 to 0.65). A multivariate model indicated a higher RR of 1.73 for traumatic brain injury (95% CI, 1.71 to 1.73) and daily combat noise exposure (1.17, 95% CI, 1.14 to 1.17) than age (0.998, 95% CI, 0.997 to 0.998). Subjects≤ 40 years of age had small but significantly elevated hearing thresholds through all standard frequencies compared to Veterans without tinnitus, and the effect of tinnitus on hearing thresholds diminished with age. In the hazard model, those> 40 with new onset of tinnitus were at risk for hearing loss sooner and with greater incidence than those who were younger. The rate of hearing loss following tinnitus approached 100%. In contrast, only approximately 50% of those who self-reported hearing loss initially were at risk for later hearing loss, in contrast to ICD comparison, where those with ICD of hearing loss were more likely to sustain an ICD of tinnitus subsequently.Conclusions:Evidence suggests that the occurrence of tinnitus in the military is more closely related to environmental exposures than to aging. The finding that tinnitus affects hearing frequencies across the audiogram spectrum suggests an acoustic injury independent of tonotopicity. Particularly for males> 40, tinnitus may be a harbinger of audiologic damage predictive of later hearing loss.