Park, R.J. & Moon, J.D. Department of Occupational and Environmental Medicine, Chonnam National University Medical School, Gwangju, Korea Accepted for publication 15 February 2014 Clin. Otolaryngol. 2014, 39, 89–94
Objectives: The aim of this study was to examine the association between tinnitus and several potential risk factors in Korean population. Design: A cross-sectional study. Setting: Based on data from the fifth Korean National Health and Nutrition Examination Survey. Participants: The study included 10 061 Korean individuals. Main outcome measures: Tinnitus was assessed by using a questionnaire, and otorhinolaryngologic examination was conducted. Risk factors associated with tinnitus were evaluated using a multiple logistic regression analysis. Results: Of the 10 061 participants ranging from 20 to 97 years old, the overall prevalence of any tinnitus was 21.4% and annoying tinnitus was 7.3%. In a multivariable logistic regression model, the following factors were associated with
Introduction
Tinnitus is the perceived sensation of sound in the absence of a corresponding external acoustic stimulus.1 In Korea, the number of people suffering from tinnitus has rapidly increased, and the National Health Insurance Service estimated that medical treatment for tinnitus exceeded 264,000 patients in 2009, an increase of 1.9 times from 2002. As a result, the rate of tinnitus has averaged annual increases of 9.3% between 2002 and 2009.2 Many patients with tinnitus report symptoms such as frustration, annoyance, irritability, anxiety, depression, hearing difficulties, hyperacusis, insomnia, and concentration difficulties.3 Tinnitus is clinically heterogeneous, and its complexity reflects the multitude of potential etiologies.4 But its pathological mechanisms and clinical features are still not fully understood.5 Correspondence: J. D. Moon, Department of Occupational and Environmental Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-Gu, Gwangju 501-746 Korea. Tel.: 82-61-379-7787; Fax: 82-61-379-7791; e-mail: [email protected] © 2014 John Wiley & Sons Ltd Clinical Otolaryngology 39, 89–94
having tinnitus: occupational noise exposure [any tinnitus, odd ratio (OR) = 1.34; annoying tinnitus, OR = 1.47], nonoccupational noise exposure (any tinnitus, OR = 1.48; annoying tinnitus, OR = 2.02), hearing impairment (any tinnitus, OR = 2.27; annoying tinnitus, OR = 3.61), chronic otitis media (any tinnitus, OR = 1.53; annoying tinnitus, OR = 1.36), chronic rhinosinusitis (any tinnitus, OR = 1.38; annoying tinnitus, OR = 1.38), temporomandibular disorder (any tinnitus, OR = 1.69; annoying tinnitus, OR = 1.90), depression (any tinnitus, OR = 1.44; annoying tinnitus, OR = 1.70), and higher stress level (any tinnitus, OR = 1.28; annoying tinnitus, OR = 1.76). Conclusions: These results suggest that tinnitus is common in Korea and may be associated with some avoidable risk factors.
We investigated the relation between tinnitus and several potential risk factors using data from the fifth Korean National Health and Nutrition Examination Survey (KNHANES), a large nationally representative survey. Materials and methods Data source
The present study used the data subset of the Korean National Health and Nutrition Examination Survey V (KNHANES V) of 2010–2011. The KNHANES collected representative data on the health and nutritional status of the civilian, non-institutionalised Korean general population to monitor trends towards the prevalence, treatment, and control of selected chronic diseases and analyse risk factors for chronic diseases. Survey items were selected from review of previous KNHANES and similar foreign surveys by the Korea Centers for Disease Control and Prevention, and then, items were confirmed by an advisory committee. Professionally trained staff administered face-to-face interviews to obtain information on sociodemographic characteristics, 89
ORIGINAL ARTICLE
Prevalence and risk factors of tinnitus: the Korean National Health and Nutrition Examination Survey 2010–2011, a cross-sectional study
90
R.J. Park & J.D. Moon
lifestyle, health, and nutritional status using structured questionnaires. A stratified multistage clustered probability design was used to select representative samples of noninstitutionalised Korean civilians for the KNHANES.6 The survey data were publicly available. Ethical considerations
The study was approved by the Korea Centers for Disease Control and Prevention Institutional Review Board. Written informed consent was obtained from all study participants. Study population
In total, 21 527 individuals (10 938 in 2010 and 10 589 in 2011) responded to the KNHANES V, but 17 476 individuals (81.9% in 2010 and 80.4% in 2011) participated in the health interviews and health examinations. Study participants were limited to at least 20 years of age (n = 13 165). After excluding those who did not receive otorhinolaryngologic examination (n = 2577) and had missing values for exposure variables (n = 527), the final sample for the present study was composed of 10 061 individuals (5157 in 2010 and 4904 in 2011). Assessment of tinnitus
Because there are no standardised questions of tinnitus,7–14 we used modified questions from the United States National Health and Nutrition Examination Survey (USNHANES).12 Tinnitus was defined as answering ‘yes’ to the question, ‘In the past year have you ever had ringing, roaring, or buzzing in your ears?’ This was followed by the question, ‘How much these sounds cause annoyance in your life?’ Annoying tinnitus was defined as answering ‘annoyed and bothered’ or ‘have problems getting to sleep’ to this question. Assessment of ear and nose
The hearing threshold was measured in a sound-proof booth by using an automatic audiometer. Hearing threshold testing was conducted on both ears of examinees at 6 frequencies (500, 1000, 2000, 3000, 4000, and 6000 Hz). We defined hearing impairment as a pure tone mean of >25 decibels at 500, 1000, 2000, and 4000 Hz in either ear. An ear examination was then conducted. A 4-mm 0°-angled rigid endoscope was used to perform endoscopic examinations in order to determine chronic otitis media. Chronic rhinosinusitis was diagnosed when the subjective symptoms of both nasal obstruction and nasal discharge were present for more than 3 months and an intranasal endoscopic examination that showed objective findings of discoloured nasal drainage
or polyps. The Epidemiologic Survey Committee of the Korean Otolaryngologic Society verified the quality control of the survey. Assessment of other variables
Anthropometric measurements of participants were conducted at local community health centres and clinics as a part of the health examination. The anthropometric variables (height and body weight) were recorded by using a standard protocol. Body mass index was calculated as weight in kilograms divided by height in metres squared. Information on the smoking (‘never’, ‘former’, and ‘current smoking’) and drinking (‘never’, ‘former’, and ‘current drinking’) status of the participants was obtained from a questionnaire survey. To assess noise exposure, participants were asked about the presence or absence of exposure to occupational noise at least 3 months or non-occupational noise at least 5 h in a week. In addition, participants were asked about past/current histories of hypertension, diabetes mellitus, hyperlipidemia, stroke, coronary heart disease (angina or myocardial infarction), stroke, temporomandibular disorder, rheumatoid arthritis, and depression. We also obtained perceived stress level from a questionnaire developed by the Korea Institute for Health and Social Affairs. Perceived stress level was classified into four categories (almost never, sometimes, fairly often, and very often). Statistical analysis
Data from the two surveys (KNHANES 2010 and 2011) were combined. The descriptive data have been presented as the mean (with standard deviations) or as percentages. We obtained the odds ratio (OR) and two-sided 95% confidence interval (CI) using a multiple logistic regression analysis. The odds ratio is one of a range of statistics used to assess the risk of a particular outcome (or disease) if a certain factor (or exposure) is present. The odds ratio is a relative measure of risk, telling us how much more likely it is that someone who is exposed to the factor under study will develop the outcome as compared to someone who is not exposed. Logistic regression was performed with sex (male, female), age (20–29, 30–39, 40–49, 50–59, 60–69, ≥70), smoking status (never or former smoking, current smoking), drinking status (never or former drinking, current drinking), body mass index (
Objectives: The aim of this study was to examine the association between tinnitus and several potential risk factors in Korean population. Design: A cross-sectional study. Setting: Based on data from the fifth Korean National Health and Nutrition Examination Survey. Participants: The study included 10 061 Korean individuals. Main outcome measures: Tinnitus was assessed by using a questionnaire, and otorhinolaryngologic examination was conducted. Risk factors associated with tinnitus were evaluated using a multiple logistic regression analysis. Results: Of the 10 061 participants ranging from 20 to 97 years old, the overall prevalence of any tinnitus was 21.4% and annoying tinnitus was 7.3%. In a multivariable logistic regression model, the following factors were associated with
Introduction
Tinnitus is the perceived sensation of sound in the absence of a corresponding external acoustic stimulus.1 In Korea, the number of people suffering from tinnitus has rapidly increased, and the National Health Insurance Service estimated that medical treatment for tinnitus exceeded 264,000 patients in 2009, an increase of 1.9 times from 2002. As a result, the rate of tinnitus has averaged annual increases of 9.3% between 2002 and 2009.2 Many patients with tinnitus report symptoms such as frustration, annoyance, irritability, anxiety, depression, hearing difficulties, hyperacusis, insomnia, and concentration difficulties.3 Tinnitus is clinically heterogeneous, and its complexity reflects the multitude of potential etiologies.4 But its pathological mechanisms and clinical features are still not fully understood.5 Correspondence: J. D. Moon, Department of Occupational and Environmental Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-Gu, Gwangju 501-746 Korea. Tel.: 82-61-379-7787; Fax: 82-61-379-7791; e-mail: [email protected] © 2014 John Wiley & Sons Ltd Clinical Otolaryngology 39, 89–94
having tinnitus: occupational noise exposure [any tinnitus, odd ratio (OR) = 1.34; annoying tinnitus, OR = 1.47], nonoccupational noise exposure (any tinnitus, OR = 1.48; annoying tinnitus, OR = 2.02), hearing impairment (any tinnitus, OR = 2.27; annoying tinnitus, OR = 3.61), chronic otitis media (any tinnitus, OR = 1.53; annoying tinnitus, OR = 1.36), chronic rhinosinusitis (any tinnitus, OR = 1.38; annoying tinnitus, OR = 1.38), temporomandibular disorder (any tinnitus, OR = 1.69; annoying tinnitus, OR = 1.90), depression (any tinnitus, OR = 1.44; annoying tinnitus, OR = 1.70), and higher stress level (any tinnitus, OR = 1.28; annoying tinnitus, OR = 1.76). Conclusions: These results suggest that tinnitus is common in Korea and may be associated with some avoidable risk factors.
We investigated the relation between tinnitus and several potential risk factors using data from the fifth Korean National Health and Nutrition Examination Survey (KNHANES), a large nationally representative survey. Materials and methods Data source
The present study used the data subset of the Korean National Health and Nutrition Examination Survey V (KNHANES V) of 2010–2011. The KNHANES collected representative data on the health and nutritional status of the civilian, non-institutionalised Korean general population to monitor trends towards the prevalence, treatment, and control of selected chronic diseases and analyse risk factors for chronic diseases. Survey items were selected from review of previous KNHANES and similar foreign surveys by the Korea Centers for Disease Control and Prevention, and then, items were confirmed by an advisory committee. Professionally trained staff administered face-to-face interviews to obtain information on sociodemographic characteristics, 89
ORIGINAL ARTICLE
Prevalence and risk factors of tinnitus: the Korean National Health and Nutrition Examination Survey 2010–2011, a cross-sectional study
90
R.J. Park & J.D. Moon
lifestyle, health, and nutritional status using structured questionnaires. A stratified multistage clustered probability design was used to select representative samples of noninstitutionalised Korean civilians for the KNHANES.6 The survey data were publicly available. Ethical considerations
The study was approved by the Korea Centers for Disease Control and Prevention Institutional Review Board. Written informed consent was obtained from all study participants. Study population
In total, 21 527 individuals (10 938 in 2010 and 10 589 in 2011) responded to the KNHANES V, but 17 476 individuals (81.9% in 2010 and 80.4% in 2011) participated in the health interviews and health examinations. Study participants were limited to at least 20 years of age (n = 13 165). After excluding those who did not receive otorhinolaryngologic examination (n = 2577) and had missing values for exposure variables (n = 527), the final sample for the present study was composed of 10 061 individuals (5157 in 2010 and 4904 in 2011). Assessment of tinnitus
Because there are no standardised questions of tinnitus,7–14 we used modified questions from the United States National Health and Nutrition Examination Survey (USNHANES).12 Tinnitus was defined as answering ‘yes’ to the question, ‘In the past year have you ever had ringing, roaring, or buzzing in your ears?’ This was followed by the question, ‘How much these sounds cause annoyance in your life?’ Annoying tinnitus was defined as answering ‘annoyed and bothered’ or ‘have problems getting to sleep’ to this question. Assessment of ear and nose
The hearing threshold was measured in a sound-proof booth by using an automatic audiometer. Hearing threshold testing was conducted on both ears of examinees at 6 frequencies (500, 1000, 2000, 3000, 4000, and 6000 Hz). We defined hearing impairment as a pure tone mean of >25 decibels at 500, 1000, 2000, and 4000 Hz in either ear. An ear examination was then conducted. A 4-mm 0°-angled rigid endoscope was used to perform endoscopic examinations in order to determine chronic otitis media. Chronic rhinosinusitis was diagnosed when the subjective symptoms of both nasal obstruction and nasal discharge were present for more than 3 months and an intranasal endoscopic examination that showed objective findings of discoloured nasal drainage
or polyps. The Epidemiologic Survey Committee of the Korean Otolaryngologic Society verified the quality control of the survey. Assessment of other variables
Anthropometric measurements of participants were conducted at local community health centres and clinics as a part of the health examination. The anthropometric variables (height and body weight) were recorded by using a standard protocol. Body mass index was calculated as weight in kilograms divided by height in metres squared. Information on the smoking (‘never’, ‘former’, and ‘current smoking’) and drinking (‘never’, ‘former’, and ‘current drinking’) status of the participants was obtained from a questionnaire survey. To assess noise exposure, participants were asked about the presence or absence of exposure to occupational noise at least 3 months or non-occupational noise at least 5 h in a week. In addition, participants were asked about past/current histories of hypertension, diabetes mellitus, hyperlipidemia, stroke, coronary heart disease (angina or myocardial infarction), stroke, temporomandibular disorder, rheumatoid arthritis, and depression. We also obtained perceived stress level from a questionnaire developed by the Korea Institute for Health and Social Affairs. Perceived stress level was classified into four categories (almost never, sometimes, fairly often, and very often). Statistical analysis
Data from the two surveys (KNHANES 2010 and 2011) were combined. The descriptive data have been presented as the mean (with standard deviations) or as percentages. We obtained the odds ratio (OR) and two-sided 95% confidence interval (CI) using a multiple logistic regression analysis. The odds ratio is one of a range of statistics used to assess the risk of a particular outcome (or disease) if a certain factor (or exposure) is present. The odds ratio is a relative measure of risk, telling us how much more likely it is that someone who is exposed to the factor under study will develop the outcome as compared to someone who is not exposed. Logistic regression was performed with sex (male, female), age (20–29, 30–39, 40–49, 50–59, 60–69, ≥70), smoking status (never or former smoking, current smoking), drinking status (never or former drinking, current drinking), body mass index (
