Impact of TBI, PTSD, and Hearing Loss on Tinnitus Progression in a US Marine Cohort

Mil Med. 2019 Dec 1;184(11-12):839-846. doi: 10.1093/milmed/usz016.


Introduction: Mild TBI (TBI) is associated with up to a 75.7% incidence of tinnitus, and 33.0% of tinnitus patients at the US Veterans Administration carry a diagnosis of post-traumatic stress syndrome (PTSD). Yet factors contributing to new onset or exacerbation of tinnitus remain unclear.

Materials and methods: Here we measure intermittent and constant tinnitus at two time points to ascertain whether pre-existing or co-occurring traumatic brain injury (TBI), hearing loss, or post-traumatic stress disorder (PTSD) predicts new onset, lack of recovery and/or worsening of tinnitus in 2,600 United States Marines who were assessed before and after a combat deployment.

Results: Ordinal regression revealed that constant tinnitus before deployment was likely to continue after deployment (odds ratio [OR] = 28.62, 95% confidence interval [CI]: 9.84,83.26). Prior intermittent tinnitus increased risk of post-deployment constant tinnitus (OR = 4.95, CI: 2.97,8.27). Likelihood of tinnitus progression increased with partial PTSD (OR = 2.39, CI: 1.50,3.80) and TBI (OR = 1.59, CI: 1.13,2.23), particularly for blast TBI (OR = 2.01, CI: 1.27,3.12) and moderate to severe TBI (OR = 2.57, CI: 1.46,4.51). Tinnitus progression also increased with low frequency hearing loss (OR = 1.94, CI: 1.05,3.59), high frequency loss (OR = 3.01, CI: 1.91,4.76) and loss across both low and high frequency ranges (OR = 5.73, CI: 2.67,12.30).

Conclusions: Screening for pre-existing or individual symptoms of PTSD, TBI, and hearing loss may allow for more focused treatment programs of comorbid disorders. Identification of those personnel vulnerable to tinnitus or its progression may direct increased acoustic protection for those at risk.

Keywords: hearing loss; post-traumatic stress disorder; tinnitus; traumatic brain injury.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Brain Injuries, Traumatic / complications*
  • Brain Injuries, Traumatic / epidemiology
  • Brain Injuries, Traumatic / psychology
  • Cohort Studies
  • Disease Progression
  • Female
  • Hearing Loss / complications*
  • Hearing Loss / epidemiology
  • Hearing Loss / psychology
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Military Personnel / psychology
  • Military Personnel / statistics & numerical data*
  • Odds Ratio
  • Prospective Studies
  • Stress Disorders, Post-Traumatic / complications*
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / psychology
  • Surveys and Questionnaires
  • Tinnitus / epidemiology
  • Tinnitus / etiology*
  • United States / epidemiology