|Year : 2012 | Volume
| Issue : 4 | Page : 196-199
Analysis of etiological factors of tinnitus in patients attending Kathmandu University Hospital
Bikash Lal Shrestha, Ram Chaya Man Amatya, Inku Shrestha, Monika Pokharel
Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University Hospital, Kavre, Nepal
|Date of Web Publication||19-Dec-2012|
Bikash Lal Shrestha
Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University Hospital, Kavre
Source of Support: None, Conflict of Interest: None
Background: Because of the subjective nature of tinnitus, variation of causes, and diversity of patients, this subject is a complex topic to study and understand. The main aim of our study was to find the frequency of tinnitus and also analyze its etiological factors. Since this kind of study has not been performed previously in Nepal, we conducted this study to know the different etiological factors related to tinnitus. Materials and Methods: One hundred and fifty-two patients who came to outpatient at Department of Otorhinolaryngology from 1 August 2011 to 1 August 2012 with history of tinnitus were included after taking informed consent, except six patients who had a co-existing psychiatric problem. Detailed history, clinical examination, and all necessary investigations were done to reach diagnosis. Data were collected and analyzed using SPSS 16.0 software. Results: There were a total 13,598 outpatients who came to Department of Otorhinolaryngology from 1 August 2011 to 1 August 2012. Among them 158 had a history of tinnitus, but six patients were excluded from the study because of a co-existing psychiatric problem. So frequency was found to be 1.11%. Regarding age distribution, 60.6% of the patients were <40 years. Mean age was 41.22 (±17.33) years. Regarding sex distribution, females were affected more than males. Housewives and businessman accounted for 58.5%. In distribution of ethnic group, Newar ethnicity accounted for 49.3% whereas Tamang ethnicity accounted for only 3.3%. Likewise, the right ear was affected more than the left ear. In distribution of etiological factors, mainly conductive hearing loss and sensorineural hearing loss were responsible, whereas an unknown cause was also responsible in 22.4% of the cases. Conclusion: Tinnitus is a distressing symptom, which causes a decrease in the quality of life. So it is important to find the sociodemographic factors and also the main etiological factors related to tinnitus as these findings will help to find out remedial measures and improvement in quality of life.
Keywords: Aetiological factor, Otorhinolaryngology, Tinnitus
|How to cite this article:|
Shrestha BL, Amatya RM, Shrestha I, Pokharel M. Analysis of etiological factors of tinnitus in patients attending Kathmandu University Hospital. Indian J Otol 2012;18:196-9
|How to cite this URL:|
Shrestha BL, Amatya RM, Shrestha I, Pokharel M. Analysis of etiological factors of tinnitus in patients attending Kathmandu University Hospital. Indian J Otol [serial online] 2012 [cited 2020 Jun 2];18:196-9. Available from: http://www.indianjotol.org/text.asp?2012/18/4/196/104798
| Introduction|| |
Tinnitus is defined as perception of sound for more than 5 min at a time, in the absence of any external acoustical or electrical stimulation of the ears, and not occurring immediately after exposure to loud noise.  The study performed by Davis and Rafaie  showed that prevalence of tinnitus in adult ranges from 10.1% to 14.5%. However, prevalence of clinical tinnitus in patients who seek medical advice is around 7.2% and mainly in the urban population.  About 20% of patients with tinnitus have difficulty in coping with the symptoms, which significantly affects their quality of life. Several studies have attempted to investigate the causative factors of tinnitus. ,,,,,,,,,,, These factors include hearing impairment, noise exposure, head - and - neck injuries, medication, ear diseases, cardiovascular diseases, lifestyle factors, and mental status. ,
The study performed by Nicolas-Puel et al. showed that the most common pathologies associated with tinnitus are acoustic trauma (32%), Meniere's disease (32%), and presbycusis (23%), respectively. Similarly, the study performed by Hazell  showed that otological disease causes tinnitus in 25% of cases, whereas in >50% of cases psychological or stress factors play a major role.
Likewise the study performed by Axelsson  showed that in 60.6% of cases tinnitus is mainly caused by sensorineural hearing loss, whereas in 7.5% of cases it is unknown.
Because of the subjective nature of tinnitus, variation of causes, and diversity of patients, this subject is a complex topic to study and understand.
The main aim of our study was to find the frequency of tinnitus and also analyze its etiological factors. Since this kind of study has not been performed previously in Nepal, we conducted this study to know the different etiological factors related to tinnitus.
| Materials and Methods|| |
This was a prospective, non-randomized, longitudinal study conducted at Department of Otorhinolaryngology and Head and Neck Surgery, Kathmandu University Hospital (Dhulikhel, Nepal), from 1 August 2011 to 1 August 2012. All patients who came to the outpatient department with a history of tinnitus were included after taking informed consent, except those who had a co-existing psychiatric problem. After collection of personal data all patients underwent to a careful detailed medical history to identify tinnitus-related pathologies and other health diseases, which included ear, nose, and throat specialist history, and otological examination. For data analysis the following parameters were considered: Age, sex, occupation, ethnic groups, laterality of tinnitus, etiological factors. In order to identify the cause of tinnitus, the following investigations were considered: Pure-tone audiogram; tympanometry; blood investigations such as hematocrit, blood bio chemistries, thyroid studies, and lipid profile; color Doppler ultrasonography (USG Doppler) to evaluate blood flow disturbance in the vertebral and basilar artery; middle/inner ear high-resolution computerized tomography scan (CT); and, in the case of suspicion of vestibular schwannoma or neurovascular conflict, magnetic resonance imaging/angio-CT (MRI/angio-CT). Data were collected and analyzed using SPSS 16.0 software.
| Results|| |
There were total 13,598 outpatients who came to Department of Otorhinolaryngology from 1 August 2011 to 1 August 2012. Among them 158 patients had a history of tinnitus, but six patients were excluded from the study because of a co-existing psychiatric problem. So frequency was found to be 1.11%.
Regarding age distribution, 60.6% of the patients were <40 years as shown in [Table 1]. Mean age was 41.22 (±17.33) years.
Regarding sex distribution, females were affected more than males as shown in [Table 2].
Housewives and businessman account for 58.5% as shown in [Table 3].
In distribution of ethnic group, Newar ethnicity accounted for 49.3% whereas Tamang ethnicity accounted for only 3.3% as shown in [Table 4].
Likewise, the right ear was affected more than the left ear as shown in [Table 5].
In distribution of etiological factors, mainly conductive hearing loss and sensorineural hearing loss were responsible, whereas an unknown cause was also responsible in 22.4% of cases as shown in [Table 6].
| Discussion|| |
Patients who complained of tinnitus used to have varying degrees of annoyance with this complain and also varying degrees of impact on quality of life.
The frequency of tinnitus in our study was 1.11%, which is lesser than in studies performed by different authors in different countries, which ranges from 5% to 32%. ,,,,,, This less frequency in our study could be because of our hospital-based study, which shows only the tip of the iceberg. Frequency would be greater if we perform the study in the community.
There are varying degrees of epidemiological data regarding age distribution. Our study showed that 60.6% of patients were in the <40 years age group, which was in contrast to the different studies, which showed that there is a strong association of tinnitus with increasing age. These various study showed that tinnitus is more prevalent between 61 and 70 years followed by lower decades of 41-50 years. ,,, This vast difference in the age group in our study could be because the old population from the village areas did not come to hospital frequently for their problem, whereas the young age groups are more conscious regarding their problem and frequently seek medical advice.
Regarding gender, the findings of our study were similar to the study performed by Coles  , Cooper,  and Pinto et al.,  which showed that females were affected more than males, whereas another study showed that males were affected more than females. ,, This higher number of females may be because women generally have more time to seek medical advice and also the female population is greater in our community.
Our study showed that housewives and business holders were mainly affected by tinnitus, which accounted for nearly 58.5%. The reason could be, the housewives in our community watch television more frequently and have noise exposure more often. Similarly, business holders also work in urban areas where there is a lot of noise pollution.
Regarding ethnic group, our study showed that the Newar ethnic groups (49.3%) were mostly affected. Such a huge Newar population affected by tinnitus is because of a large Newar community nearby the hospital area.
Our study showed that the right ear was affected more than the left or bilateral ear, which differs from other studies, which showed that the left ear was affected more than the right ear, , although another study showed that there was no significant difference between the two ears. 
This may be because of considerable variation in tinnitus laterality with age and gender. 
Regarding etiological factors, our study showed that the chronic otitis media was responsible for 22.4%, which differs from another study, which showed only 7% cause of tinnitus.  This difference is due to a large prevalence of chronic otitis media in our community.
Likewise, the etiological factor sensorineural hearing loss causing tinnitus in our study correlated with the study performed by Axelsson.  However, an unknown cause leading to tinnitus in our study accounted for 22.4%, which was much higher than Axelsson's  study but lower than the study performed by Spoendlin.  We could not find any obvious cause for this reason. However, it may be because of a disturbance in the feedback mechanism of the brain. We found that the several studies vary widely as tinnitus patients are heterogeneous groups of population in which different factors play their roles.
The main limitation of our study was that sample size was not large enough for generalization. The study should be conducted in the community to find the exact prevalence and also the etiological factors of tinnitus.
| Conclusion|| |
Tinnitus is a distressing symptom, which decreases quality of life. So it is important to find the sociodemographic factors and also the main etiological factors related to tinnitus as these findings will help to find out remedial measures and improvement in quality of life.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]