ORIGINAL ARTICLE

Tinnitus: A hospital-based retrospective

study
Hanifa Akhtar Laskar, Neizekhotuo Brian Shunyu, Jayanta Medhi, Md. Jamil1,
Collete Nongsiej, Eusebia Khyriem
Departments of Otorhinolaryngology and 1General Medicine, North Eastern Indira Gandhi Regional Institute of Health
and Medical Sciences, Shillong, Meghalaya, India

abStRact

Aims and Objectives: To find out age, sex, laterality distribution of patients with tinnitus, to investigate
the type and characteristics of associated hearing loss and to find different etiology causing tinnitus.
Materials and Methods: Retrospective hospital-based study. Data collected for 154 patients who attended
tinnitus clinic of Department of ENT of our institute during the year 2013. Patients with incomplete data
were excluded from the study. Results: Among 154 patients included for study, 73 were male and 81 were
female. The highest percentage of patients were in the middle age group of 4150 years (27.9%) followed
by 3140 years (18.83%) and 5160 years (16.2%) with decreasing number of patients in both younger
and elderly age group. Conclusion: Tinnitus can affect any age group but its prevalence increases with
age without any gender predilection. Left ear involvement is slightly more common among unilateral tinnitus.
Sensorineural hearing loss is most common factor associated but in one-sixth of the cases no cause has been
found for tinnitus.
KEywoRDS: Hearing loss, Sensorineural hearing loss, Tinnitus

intRoDuction
Tinnitus which is defined as the conscious perception of
an auditory sensation in the absence of a corresponding
external stimulus,[1] is a common ear symptom encountered
by otorhinolaryngologists. But in spite of much progress has
been made, it remains a clinical and scientific enigma. It can be
subjective when it is audible only to the patient and objective
when heard by observer also. It can be perceived unilaterally
or bilaterally and can be intermittent or constant. In general,
sensation of tinnitus is described as ringing, roaring, and
hissing.
The underlying causes of tinnitus are multifactorial and
though it is related to ear, in many cases systemic diseases
are found to be associated. In some cases, no cause has
been found even after thorough investigations. Hearing
loss is one of the most common risk factors for tinnitus
and it is commonly of sensorineural type that can be due
to ageing, noise exposure or sudden sensorineural hearing
loss(SNHL).[2,3] Other risk factors associated are middle ear
disease, Menieres disease, vestibular schwannoma, trauma,
Address for correspondence: Dr. Hanifa Akhtar Laskar,
Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional
Institute of Health and Medical Sciences, Shillong - 793 018, Meghalaya,
India. E-mail: hanifaent@gmail.com
Indian Journal of Otology | July 2015 | Vol 21 | Issue 3 |

systemic illness.[1] In spite of being a common otological

problem that can cause various somatic and psychological
problems, very few studies were done among the Indian
population that is available in the literature. Thus, the present
study was conducted among the Indian population with
following aims and objectives:
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The present study is a retrospective study in which data were
collected for 154 consecutive patients, who attended the
Department of ENT of Tertiary Care Centre of North Eastern
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DOI:
10.4103/0971-7749.159710

197

Laskar, etal.: TinnitusA hospital-based retrospective study

region of India for tinnitus in the year 2013. The study is

approved by Institution Ethical Committee.
The data were collected from the departmental audiological
record book. Information was collected about the patients
tinnitus, hearing impairment, vertigo, systemic illness, and
risk factors like noise trauma, drug history, and road traffic
accident (RTA). Audiological test, magnetic resonance
imaging(MRI) brain reports along with other relevant medical
reports were examined.
The parameters which were included for analysis of data
are: Age, sex, laterality of tinnitus (unilateral/bilateral),
duration of tinnitus (<1 month, 1 month to 1 year, more
than 1 year), hearing status (normal/hearing loss), pure
tone audiogram (within normal limit, conductive hearing
loss, SNHL, mixed loss), special tests(tone decay test, short
increment sensitivity index).
Pure tone audiogram was performed in all patients to determine
audiometric thresholds at the frequency range of 0.25 to 8 kHz
and divided into minimal, mild, moderate, moderately severe,
severe, profound hearing loss as per guidelines by American
Speech-Language-hearing Association.[4]
For analysis of data, patients were divided into nine groups
as per age in years: Up to 10, 11 to 20, 21 to 30, 31 to 40, 41 to
50, 51 to 60, 61 to 70, 71 to 80, and 81 to 90.
Those patients with incomplete data and information were
excluded from the study.

RESultS anD obSERvationS

In the present study, data were collected for 154 patients
who attended tinnitus clinic during year 2013. Total number
of male and female patients were 73 (47%) and 81 (53%)
respectively. Male:female ratio was 0.9:1. Profile of patients
with tinnitus is shown in Table 1. In present study, most
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complained of tinnitus without hearing loss and tinnitus with
hearing loss were 81(52.59%) and 73(47.4%), respectively.
In 50% of patients, tinnitus was experienced bilaterally and
among patients having unilateral tinnitus, it was more on left
side(27.2%) compared to right(22.7%). Hearing evaluation
was done by audiometry in all patients and the audiometric
findings are shown in Table2. Hearing sensitivity was found
to be within normal limit in 43(27.9%) patients and hearing
loss was identified as conductive, SNHL and mixed type in
12 (7.79%), 92 (59.7%) and 7 (4.54%) number of patients,
respectively.
Of 43(27.9%) patients with hearing sensitivity within normal
limit, 15patients demonstrated dip in audiogram at 8 K and 4 K

198

Table 1: Profile of patients with tinnitus

Factors

Number (%)

Gender
Male
Female
Age(years)
0-10
11-20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
Complaint
Only tinnitus
Tinnitus with hearing
loss
Side of tinnitus
Bilateral
Unilateral right
Unilateral left
Duration of tinnitus
<1 month
1 month-1year
More than 1year

73(47.4)
81(52.59)
01(0.64)
13(8.4)
24(15.5)
29(18.83)
43(27.9)
25(16.2)
12(7.79)
05(3.2)
02(1.29)
81(52.59)
73(47.4)

77(50)
35(22.7)
42(27.2)
36(23.37)
79(51.3)
39(25.32)

Table 2: Audiometric results in tinnitus patients

Pure tone audiogram
Within normal limit
Conductive hearing loss
Sensorineural hearing loss
Mixed hearing loss
Degree of hearing loss
Conductive loss
Minimal
Mild
Moderate
Moderately severe
Sensorineural loss
Minimal
Mild
Moderate
Moderately severe
Severe
Profound
Asymmetric
Mixed loss
Moderate
Moderately severe
Severe

Number (%)
43(27.9)
12(7.79)
92(59.7)
07(4.54)

01(8.3)
08(66.6)
02(16.6)
01(8.3)
04(4.34)
28(30.43)
21(22.82)
11(11.95)
04(4.34)
02(2.17)
22(23.9)
03(42.85)
02(28.57)
02(28.57)

in 11 and 4cases, respectively. In this group of patients, tinnitus

was present bilaterally and unilaterally in 31(72%) and 12(28%),
respectively. Of 92 tinnitus patients having SNHL positive tone
decay was found in 12cases, of which 5cases had unilateral

Indian Journal of Otology | July 2015 | Vol 21 | Issue 3 |

Laskar, etal.: TinnitusA hospital-based retrospective study

SNHL and 7cases had bilateral SNHL. MRI brain was done
in all these cases of which 2 cases were diagnosed as acoustic
neuroma and in 10patients MRI brain was found to be normal.
The causes associated with tinnitus are shown in Table3. But
cause of tinnitus could not be found in 24(15.58%) patients.

DiScuSSion
Tinnitus is one of the health issues of concern for
otorhinolaryngologists. The term tinnitus is derived from Latin
word tinnire, meaning to ring.[1] Tinnitus affects individuals
of all age strata and most commonly affects individuals of
age group40 to 70years.[5] In our study, highest number of
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predominance was found in our study. This is similar with
findings of Nondahl etal.[6] who reported a higher number of
tinnitus among females. But few studies have reported male
predominance.[7-9]
Tinnitus may be perceived unilaterally or bilaterally. In our
study, tinnitus was experienced bilaterally in 50% of patients,
similar to findings of Coles.[10] Left side predominance was
found in cases of unilateral tinnitus similar to findings of some
other studies.[8,10] But study by Alberti[11] found no significant
difference between two ears.
As tinnitus is a symptom, not a disease, many authors
have described several underlying risk factors. Among all,
hearing loss is a well-recognized risk factor of tinnitus.[2,9,12]
In our study, hearing loss was present in 72% of patients
and in majority(59.7%), it was SNHL type of hearing loss.

Our findings on type of hearing loss in tinnitus patients are

similar with other studies which also mentioned SNHL type
as commonest in patients of tinnitus with hearing loss.[3,9] The
high percentage of SNHL in tinnitus patients is explained
by theory that tinnitus results from reduction of effective
functioning of the auditory afferent system.[13]
Presbycusis is most common cause of SNHL with tinnitus in our
study. The other causes of SNHL were sudden SNHL(5.84%),
noise-induced (3.89%), Menieres disease (1.94%), cochlear
otosclerosis (1.29%), post road traffic accident (1.29%)
and systemic diseases like hypertension, diabetes, and
hypothyroidism. Causes of SNHL in tinnitus patients in our
study match with findings of other investigators.[8,14]
Magnetic resonance imaging was done in all cases of unilateral
SNHL and in SNHL with positive tone decay. Out of five cases
of unilateral SNHL with positive tone decay, two patients were
diagnosed as acoustic neuroma(1.29%).
Tinnitus with conductive hearing loss was found in 7.79% of
patients and causes were Eustachian tube dysfunction(5.19%),
chronic suppurative otitis media(0.64%), otosclerosis(0.64%),
Post-tympanoplasty (0.64%), and traumatic tympanic
membrane perforation(0.64%). Our finding does not match
with study by Shrestha etal.[15] which mentioned chronic otitis
media as cause of tinnitus in 22.4% of patients.
Audiological assessment was done by pure tone audiometer.
In patients of tinnitus with conductive hearing loss,
degree of loss was mild and moderate in 66.6% and 16.6%,
respectively. Degree of hearing loss in tinnitus with SNHL

Table 3: Causes/factors associated with tinnitus in different categories of patients

Patients with
conductive hearing
loss

Number
(%)

Patients with
sensorineural loss

Number
(%)

Patients
with mixed
loss

Number
(%)

9(5.84)

Otosclerosis

2(1.29)
30(19.48)

Eustachian tube
dysfunction
CSOM
Otosclerosis

8(5.19)

Sudden SNHL

1(0.64)
1(0.64)

RTA
Presbycusis

Post-tympanoplasty

1(0.64)

Noise-induced

6(3.89)

Traumatic membrane
perforation

1(0.64)

Menieres disease

3(1.94)

Cochlear otosclerosis
Chicken pox
Hypothyroidism
Hyperuricemia
Diabetes mellitus
Acoustic neuroma
SNHL with positive decay
and normal MRI
SNHL of unknown
etiology

2(1.29)
1(0.64)
2(1.29)
1(0.64)
1(0.64)
2(1.29)
10(6.49)

Total

12

Patients with normal

hearing

Number
(%)

2(1.29)

Noise trauma

5(3.24)

RTA
Presbycusis

1(0.64)
2(1.29)

5(3.24)
1(0.64)

Diabetes
mellitus
Idiopathic

1(0.64)

Anemia
Anti-tubercular drug
history
Diabetes and coronary
heart disease
Eustachian tube
dysfunction
Hypertension
Somatization disorder
Spondylosis
Vertiginous migraine
Idiopathic

1(0.64)

2(1.29)
2(1.29)
1(0.64)
1(0.64)
1(0.64)
24(15.6)

23(14.93)
92

SNHL: Sensorineural hearing loss, MRI: Magnetic resonance imaging, RTA: Road traffic accident, CSOM: Chronic suppurative otitis media

Indian Journal of Otology | July 2015 | Vol 21 | Issue 3 |

1(0.64)

43

199

Laskar, etal.: TinnitusA hospital-based retrospective study

was mild, moderate, and asymmetric in 30%, 23%, and 24%,

respectively. In our study, majority of tinnitus patients with
hearing loss had mild loss(32.43%) followed by moderate
loss (23.42%), moderately severe loss (12.61%), severe
loss(5.4%), profound loss(1.8%). Our result does not match
with findings of study by Dias and Cordeiro[16] that found
higher prevalence of tinnitus among patients with higher
degree of hearing loss.
Tinnitus can be present in patients with normal hearing.
In our study, 27.9% patients had hearing sensitivity within
normal limit. Among patients with normal hearing, 34.8%
of patients demonstrated dip at 4 K and 8 K in audiogram.
Our findings are identical with some studies [9,17] that
mentioned pathogenesis of tinnitus in normal hearing
patients with high-frequency dip may be due to disturbance
in activity along tonotopic axis in auditory pathway, which
is not documented in audiometrically normal thresholds.
In present study, this group of patients had associated
systemic diseases such as anemia, diabetes, hypertension,
somatization disorder, and previous history of noise
exposure.

REfEREncES
1.
2.

3.

4.
5.
6.

7.
8.

9.

In spite of thorough investigations, no cause of tinnitus could

be established in 15.58% of our patients. But in other studies by
Martines etal.[9] and Savastano,[18] percentage of unidentified
etiology of tinnitus was higher and was 26% and 30.77%,
respectively.

10.

concluSion

13.

The present study reveals that tinnitus can affect all age groups
but middle age group and above are more commonly affected
without any significant gender predilection. Tinnitus can affect
unilaterally or bilaterally with slight left ear predominance
among patients with unilateral tinnitus. Audiometric results
showed SNHL in majority with the presence of conductive
and mixed hearing loss in minority of patients. But a quarter
of patients had normal hearing. Most of our patients had
mild to moderate degree of loss. Eustachian tube dysfunction
and presbyacusis were found to be the most common cause
of tinnitus in patients with conductive hearing loss and
sensorineural loss, respectively. In patients with normal
hearing, anemia and noise trauma was found to be a common
cause of tinnitus. But even after thorough evaluation, cause of
tinnitus could not be established in around one-sixth of total
number of patients.

14.

200

11.
12.

15.

16.

17.
18.

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How to cite this article: Laskar HA, Shunyu NB, Medhi J, Jamil M,
Nongsiej C, Khyriem E. Tinnitus: A hospital-based retrospective
study. Indian J Otol 2015;21:197-200.
Source of Support: Nil. Conflict of Interest: None declared.

Indian Journal of Otology | July 2015 | Vol 21 | Issue 3 |

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