Background Patients with tinnitus may have different severity levels of tinnitus distress. Visual analog scale (VAS) is a simple method to measure the extent of subjective distress caused by tinnitus. It includes ratings of tinnitus loudness, awareness, annoyance, and impact of tinnitus on life.

Purpose The purpose of this study was to evaluate what led to different distress levels in patients with bilateral tinnitus by analyzing the relationships among all subscales of VAS scores for tinnitus distress and the documented variables.

Research Design This study was a retrospective cohort study.

Study Sample The medical records of 268 patients who visited a tinnitus clinic between March and December 2020 were reviewed.

Data Collection and Analysis Epidemiologic characteristics, subjective tinnitus distress factors including tinnitus loudness, awareness, annoyance, and impact of tinnitus on life, questionnaire results including those from the Tinnitus Handicap Inventory (THI) and Beck Depression Inventory (BDI), and audiometric profiles were documented. Based on a bivariate analysis between variables and subtypes of subjective tinnitus distress, stepwise logistic regression was performed to identify potential influencing factors for aggravating each subtype.

Results Data from a total of 122 patients with bilateral tinnitus were collected. The cohort included 77 males and 45 females with a mean age of 51.16 ± 13.50 years. Tinnitus loudness was associated with an accompanying headache (p < 0.001), the BDI score (p = 0.001), and the duration of tinnitus (p = 0.006). A high THI (p < 0.001) and an accompanying headache (p = 0.016) were both associated with tinnitus annoyance. Hearing thresholds at 250 Hz (p = 0.011) and 500 Hz (p = 0.002) on the left side were associated with an impact of tinnitus on life. The hearing threshold at 4 kHz on the left side alone was associated with tinnitus awareness (p = 0.013).

Conclusion Psychologic complaints are mainly associated with tinnitus loudness and annoyance. On the other hand, hearing loss is linked with tinnitus awareness and its impact on life. Thus, an individualized, sequential approach that considers different subtypes of tinnitus severity to assess subjective tinnitus distress is needed.

The Institutional Review Board approved this retrospective cohort study and waived the need to obtain written informed consent because of its retrospective nature (IRB number: 2021-03-005).

Any mention of a product, service, or procedure in the Journal of the American Academy of Audiology does not constitute an endorsement of the product, service, or procedure by the American Academy of Audiology.

* These authors equally contributed to this work.

Received: 24 May 2021

Accepted: 10 September 2021

Article published online:
01 September 2022

© 2021. American Academy of Audiology. This article is published by Thieme.

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