Tinnitus in Canada

Abstract

Background: Tinnitus, which has no cure, can be a temporary irritant or a life-altering condition. Many factors can precipitate tinnitus, including hearing loss,
exposure to loud noise and other otologic causes, neurological injuries or disease, dental disorders, some medications, and certain infectious diseases. This
study summarizes new tinnitus data from the Canadian Health Measures Survey (CHMS).
Data and methods: Data were collected for individuals aged 19 to 79 years (n=6,571) from 2012 through 2015 as part of the CHMS. Tinnitus is described
as “the presence of hissing, buzzing, ringing, rushing or roaring sounds in your ears when there is no other sound around you.” Bothersome tinnitus refers to
tinnitus affecting sleep, concentration or mood. Factors associated with tinnitus were examined using bivariate and logistic regression analyses.
Results: An estimated 37% of adult Canadians (9.2 million) had experienced tinnitus in the past year; it was bothersome for 7% of the population. Individuals
aged 19 to 29 were significantly more likely to have past-year tinnitus (46%) than those aged 30 to 49 (33%) and 50 to 70 (35%). Tinnitus was associated with
poor self-reported mental health, mood disorder, a weak sense of community belonging, high daily stress and poor quality sleep. People with hearing loss and
tinnitus were twice as likely as those with hearing loss alone to use hearing aids, at 11% compared with 5% respectively.
Interpretation: Tinnitus is a common condition among Canadian adults. Recent exposure to loud noise may contribute to the higher prevalence of past-year
tinnitus at younger ages. Canadians could benefit from greater awareness of tinnitus, prevention strategies and management options.

Full text

Health Reports
Catalogue no. 82-003-X
ISSN 1209-1367
by Pamela L. Ramage-Morin, Rex Banks,
Dany Pineault and Maha Atrach
Tinnitus in Canada
Release date: March 20, 2019

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3
Statistics Canada, Catalogue no. 82-003-X • Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019
Tinnitus in Canada • Research Article
Authors: Pamela L. Ramage-Morin (Pamela.Ramage-Morin@canada.ca) is with the Health Analysis Division at Statistics Canada, Ottawa, Ontario. Rex
Banks, Dany Pineault and Maha Atrach are audiologists with the Canadian Hearing Society, Toronto, Ontario.
Abstract
Background: Tinnitus, which has no cure, can be a temporary irritant or a life-altering condition. Many factors can precipitate tinnitus, including hearing loss,
exposure to loud noise and other otologic causes, neurological injuries or disease, dental disorders, some medications, and certain infectious diseases. This
study summarizes new tinnitus data from the Canadian Health Measures Survey (CHMS).
Data and methods: Data were collected for individuals aged 19 to 79 years (n=6,571) from 2012 through 2015 as part of the CHMS. Tinnitus is described
as “the presence of hissing, buzzing, ringing, rushing or roaring sounds in your ears when there is no other sound around you.” Bothersome tinnitus refers to
tinnitus affecting sleep, concentration or mood. Factors associated with tinnitus were examined using bivariate and logistic regression analyses.
Results: An estimated 37% of adult Canadians (9.2 million) had experienced tinnitus in the past year; it was bothersome for 7% of the population. Individuals
aged19to29weresignicantlymorelikelytohavepast-yeartinnitus(46%)thanthoseaged30to49(33%)and50to70(35%).Tinnituswasassociatedwith
poor self-reported mental health, mood disorder, a weak sense of community belonging, high daily stress and poor quality sleep. People with hearing loss and
tinnitus were twice as likely as those with hearing loss alone to use hearing aids, at 11% compared with 5% respectively.
Interpretation: Tinnitus is a common condition among Canadian adults. Recent exposure to loud noise may contribute to the higher prevalence of past-year
tinnitusatyoungerages.Canadianscouldbenetfromgreaterawarenessoftinnitus,preventionstrategiesandmanagementoptions.
Keywords: Hazardous noise, audiometry, quality of life, well-being
DOI: https://www.doi.org/10.25318/82-003-x201900300001-eng
Tinnitus in Canada
by Pamela L. Ramage-Morin, Rex Banks, Dany Pineault and Maha Atrach
Tinnitus is the perception of noise without an external, sound-
producing source, also described as phantom noise.1 It is
generally classied as either subjective or objective. In at least
95% of cases, tinnitus is subjective—the head or ear noises
are perceivable only to the individual.2 In contrast, objective
tinnitus occurs when the perception of sounds is generated by
sources within the body that are transmitted to the ear and can
sometimes be heard by an examiner during auscultation (i.e.,
listening to sounds from the heart, lungs and other organs).1,3
The nature of the perceived noise varies from person to person
but has been described as ringing, buzzing, roaring, grinding
or like the noise produced by crickets or cicadas, the wind, or
releasing steam.1,4 Pulsatile tinnitus is rhythmic, synchronous
with the heartbeat.1,5
The severity and persistence of tinnitus can range from a
short-term occurrence of no consequence to a chronic and
life-interfering condition.6,7 Tinnitus has been associated with
anxiety and depression, insomnia, irritation, stress, and even
suicide, although the latter may be a reection of comorbid
mental health problems.6-9
Tinnitus may be a primary condition with no known cause
beyond hearing loss, or a secondary condition to factors such as
exposure to loud noise and other otologic causes, neurological
injuries or disease, dental disorders, some medications, or certain
infectious diseases.1,6,7,10 Even when the circumstances triggering
tinnitus can be identied, the mechanisms prolonging the condi-
tion are not clear.6 The pathophysiology of tinnitus is complex
and not universally agreed upon.11,12 Most patients develop tin-
nitus as a symptom of hearing loss, caused by either age, noise
trauma, head injury or ototoxic drugs. Hearing loss causes less
external sound stimuli to reach the brain. In response, the brain
undergoes neuroplastic changes in how it processes different
sound frequencies. Tinnitus is believed to be the product of mal-
adaptive neuroplastic changes.1,3,11,12
There is no cure for tinnitus; management focuses on quality
of life and varies depending on factors such as severity, impact,
comorbid hearing loss and individual needs.13 A personalized
approach to treatment is recommended and may incorporate
counselling, sound-based therapies (e.g., tinnitus retraining
therapy), psychological therapies (e.g., cognitive behavioural
therapy), and hearing loss management (e.g., hearing aids, coch-
lear implants).13,14 Medications may be prescribed for tinnitus,
particularly when comorbid conditions such as depression or
insomnia are present.13 Individuals who experience persistent,
bothersome tinnitus that has the potential to negatively affect
quality of life are the focus for intervention.6,15
Until recently, clinicians relied on U.S. data to esti-
mate the prevalence of tinnitus in the Canadian population.
Approximately 50 million U.S. adults experienced tinnitus in
the past year, and 16 million had it almost all the time or at
least on a daily basis.16 Data from the 2012 to 2013 Canadian
Health Measures Survey (CHMS) show that 43% of Canadians
aged 16 to 79 (11.5 million) had experienced tinnitus during
their lifetime and that 35% had experienced the condition within
the past year.17 The release of more recent CHMS data (2014
to 2015) combined with the earlier cycle permits more in-depth
analyses of past-year tinnitus in Canada. This includes estimates
of bothersome tinnitus and an exploration of factors associated
with the condition, specically noise sources, chronic condi-
tions, measures of well-being, hearing loss and hearing aid use.
This information will be valuable for raising awareness about
tinnitus, planning treatment and conducting future research in
Canada.

4Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019 • Statistics Canada, Catalogue no. 82-003-X
Tinnitus in Canada • Research Article
What is already
known on this
subject?
■Tinnitus ranges in severity from
a temporary inconvenience to a
chronic, life-interfering condition.
■Tinnitus can be the result of hearing
loss, exposure to loud noise and
other otologic causes, neurological
injuries or disease, dental disorders,
some medications, and certain
infectious diseases.
■Tinnitus becomes increasingly
common at older ages.
What does this study
add?
■An estimated 37% of adult
Canadians (9.2 million) had
experienced tinnitus in the past
year; 7% had tinnitus that was
bothersome, affecting aspects of their
lives such as sleep, concentration
and mood.
■Younger people aged 19 to 29 were
more likely than those in older age
groups to report past-year tinnitus.
■Use of audio devices with
headphones or earbuds and
exposure to amplified music and loud
noise at events were more common
among younger people, which is one
possible explanation for the higher
prevalence of tinnitus at younger
ages.
■Men were more likely than women to
have experienced tinnitus; however,
this difference could be accounted
for by their greater exposure, in
general, to loud noise at work, school
or leisure.
■People with tinnitus were more likely
than those without the condition to
report poor mental health, mood
disorder, high daily stress, a weak
sense of community belonging and
poor quality sleep.
Methods
Data source
The CHMS is an ongoing cross-sectional
survey that samples households from ve
regions across Canada (Atlantic, Quebec,
Ontario, Prairies and British Columbia).
Participants provide demographic,
socioeconomic, health and lifestyle
information through an in-person, com-
puter-assisted household interview,
followed by direct physical measure-
ments collected at a mobile examination
centre (MEC). The CHMS excludes
full-time members of the Canadian
Armed Forces; residents of the three
territories, First Nations reserves and
other Aboriginal settlements, and certain
remote regions; and residents of institu-
tions such as nursing homes. Altogether,
these exclusions represent approximately
4% of the target population. Proxy inter-
views were accepted in cases of physical
or intellectual impairment.
Data from cycles 3 and 4 (2012 to 2013
and 2014 to 2015) were combined for
this analysis. For each cycle, data were
collected from January (year 1) through
December (year 2) at 16 randomly
selected sites and two MECs distributed
across the ve regions. The combined
response rate for cycles 3 and 4, house-
hold and MEC components was 52.7%.
Details regarding sampling design, data
collection and calculation of response
rates are available in the CHMS data
user guides18,19 and the Instructions for
Combining Multiple Cycles of Canadian
Health Measures Survey (CHMS) Data.20
Further information on sampling frame
and data collection are available at www.
statcan.gc.ca.
Study sample
This study was based on a sample of
6,571 respondents (3,250 men and
3,321 women) aged 19 to 79 years. The
weighted sample from cycles 3 (n=3,288)
and 4 (n=3,283) represented a population
of 25.9 million Canadians. For detailed
descriptions of the weighting process
permitting population estimates to be cal-
culated from the sample, see the CHMS
data user guides.18,19
Denitions
Tinnitus was described as “the presence
of hissing, buzzing, ringing, rushing or
roaring sounds in [the] ears when there
is no other sound around.” Respondents
who had experienced tinnitus within
the past year are the focus of this study.
These respondents were asked whether
the tinnitus bothered them by affecting
their sleep, concentration or mood, for
example. Those who responded “yes”
were considered to have bothersome
tinnitus.
Selected sources of past-year exposure
to loud noise at work, school or leisure
were amplied music (e.g., concert),
power tools, sporting or entertainment
events (e.g., hockey game), and rearms
(e.g., guns). Loud noise was self-re-
ported; it was described to respondents as
a volume that required them to speak in a
raised voice to be understood or to com-
municate with someone at arm’s length.
Respondents indicated all sources that
applied. This subset of all sources of loud
noise was selected because there were
follow-up questions about the source’s
effect on tinnitus.
Respondents were questioned about
their use of headphones or earbuds
for listening to music, movies or other
types of audio on devices such as MP3
players, iPods, cell phones, stereo
systems, televisions and computers.
Individuals referred to as device users
responded “yes” to the following ques-
tion: “In the past 12 months, have you
listened to audio devices using head-
phones or earbuds?” Additionally, these
respondents were asked, “On average,
in the past 12 months, how many hours
per week did you usually listen to music,
movies or other types of audio using
headphones or earbuds?” Users who
responded zero hours and minutes, as
well as those who did not specify average
weekly use, were considered occasional
users and retained for the estimation of
mean listening hours. Mean weekly hours
of use and use at loud volume in the past
12 months were estimated by age group.
A “yes” response to either or both of the
following questions established loud

5
Statistics Canada, Catalogue no. 82-003-X • Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019
Tinnitus in Canada • Research Article
volume: “Is the volume level usually at
or above three quarters of the maximum
volume?” and, “Is the volume usually
so loud that someone standing an arm’s
length away would have to speak in a
raised voice for you to understand what
they were saying?” The mean number of
listening hours and loud listening hours
per week were calculated for the entire
population (non-listeners contributed
zero hours) and for the subpopulation
of listeners (occasional listeners contrib-
uted zero hours). Including occasional
listeners provides a more conservative
estimate of mean weekly hours than if
occasional listeners had been excluded.
A dichotomous variable, created for
use in the logistic regression model,
grouped respondents who had been
exposed to loud noise from one or more
of the selected sources or used head-
phones or earbuds with audio devices
versus adults with none of these noise
exposures.
Respondents were asked about long-
term (lasting or expected to last at least
six months) conditions that have been
diagnosed by a health professional.
The chronic conditions selected for this
analysis were those that have been asso-
ciated with tinnitus directly or because
of treatment-related medications: high
blood pressure (including medication
use for high blood pressure in the past
month), cardiovascular disease (i.e., has
heart disease, has had a heart attack, or
suffers from the effects of a stroke), dia-
betes (excluding gestational diabetes),
kidney dysfunction or disease, and
arthritis.
Five categories of body mass index
(BMI=measured weight [kg] / measured
height [metres] squared) were examined:
underweight (<18.50 kg/m2), normal
(18.50 kg/m2 to 24.99 kg/m2), overweight
(25.00 kg/m2 to 29.99 kg/m2), obese—
class I (30.00 kg/m2 to 34.99 kg/m2), and
obese—class II and III (≥ 35.00 kg/m2).21
For exposure to smoke, respondents
were classied as smoker (daily or occa-
sional) or non-smoker (former smoker
or never smoked). Non-smokers were
subdivided by second-hand smoke
exposure, dened as living in a home
where smoking was allowed or being
exposed to second-hand smoke in private
vehicles, places of work, someone else’s
home or public indoor places.
Respondents were asked in separate
questions to rate their mental health
and quality of life. Those who reported
“poor” or “fair” were grouped together
and compared with respondents who
reported “good,” “very good” or “excel-
lent” to the respective questions.
Mood disorder was self-reported in
response to the question, “Do you have
a mood disorder such as depression,
bipolar disorder, mania or dysthymia?”
Respondents were asked: “How would
you describe your sense of belonging to
your local community? Would you say
it is very strong? Somewhat strong?
Somewhat weak? Very weak?” Those
who responded with either of the latter
two response categories were categorized
as having a weak sense of community
belonging.
Responses to the question “Thinking
about the amount of stress in your life,
would you say that most days are…?”
were categorized as high daily stress
(“quite a bit” or “extremely stressful”)
versus low daily stress (“not at all,” “not
very” or “a bit stressful”).
People who responded “never” or
“rarely” to the question “How often do
you nd your sleep refreshing?” were
considered to have poor quality sleep,
compared with those who responded
“sometimes,” “most of the time,” or “all
of the time.”
Hearing loss was established using
audiometric evaluation. It was dened
as a unilateral or bilateral threshold
above 25 dB in the worse ear, based
on four frequency pure-tone average
(PTA) across 0.5, 1, 2 and 4 kHz; high
frequency PTA across 3, 4, 6 and 8 kHz;
and low frequency PTA across 0.5, 1 and
2 kHz. Individuals with a PTA above the
25 dB threshold over high, low or four
frequencies were classied as having
hearing loss. The hearing loss threshold
for adults aged 19 or older was based on
the American Speech-Language-Hearing
Association guidelines.22 Audiometric
testing was conducted by health measures
specialists with training and supervision
provided by a certied audiologist who
ensured quality control. Testing was
carried out while respondents were
seated in a portable audiometric booth
(Eckel AB-4230), with the door closed.
Further details on the audiometric evalu-
ation are available elsewhere.23
Hearing aid users were those who
reported that they had one for their left
ear, right ear or both ears.
Analytical techniques
Weighted frequencies and cross-tabu-
lations were calculated to examine the
prevalence of past-year tinnitus by sex,
age group, noise source, hearing loss,
hearing aid use and other factors associ-
ated with tinnitus. Prevalence estimates
of adverse outcomes associated with
Table 1
Prevalence of tinnitus, past year, by sex and age group, household population aged19
to 79, Canada excluding territories, 2012 to 2015
Characteristics
Tinnitus (past year)
Total Bothersome Non-bothersome
Number
‘000 %
95%
confidence
interval Number
‘000 %
95%
confidence
interval Number
‘000 %
95%
confidence
interval
from to from to from to
Total 9,235 36.6 33.6 39.7 1,650 6.5 5.5 7.7 7,582 30.0 27.3 32.9
Sex
Men†4,864 39.3 34.4 44.5 721 5.8 4.2 8.1 4,143 33.5 29.5 37.8
Women 4,372 34.0* 31.6 36.4 930 7.2 5.8 9.0 3,439 26.7* 24.2 29.4
Age group
(years)
19 to 29†2,295 46.1 40.8 51.4 274E5.5E3.3 9.0 2,021 40.6 35.8 45.5
30 to 49 3,088 33.0* 28.3 38.0 592 6.3 4.6 8.6 2,493 26.6* 22.7 31.0
50 to 79 3,853 35.4* 30.5 40.5 784 7.2 5.4 9.5 3,069 28.2* 23.8 33.0
E use with caution
* significantly different from reference group (p<0.05)
† reference group
Source: 2012 to 2013 and 2014 to 2015 Canadian Health Measures Surveys, combined.

6Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019 • Statistics Canada, Catalogue no. 82-003-X
Tinnitus in Canada • Research Article
tinnitus are presented. A sex-adjusted
logistic regression model was used to
examine the odds of reporting past-
year tinnitus after accounting for noise
exposure. A dichotomous variable for
noise exposure grouped individuals who
had been exposed to one or more of
the selected noise sources versus those
who had no exposure to the selected
sources. Weighted mean hours of head-
phone or earbud use per week over the
past 12 months by volume were calcu-
lated overall and by age group for two
populations: the total population and
the listening population. Listeners refers
to those who self-reported headphone
or earbud use over the past year and
includes individuals who subsequently
reported zero hours of headphone or
earbud time per week on average—these
respondents were considered occasional
users. Occasional users contributed zero
hours to the mean, resulting in more con-
servative estimates. To account for the
complex survey design, 95% condence
intervals, standard errors and coefcients
of variation were calculated using the
bootstrap technique with 22 degrees of
freedom.24,25 In the tables and text, esti-
Figure 1
Percentage using audio devices with headphones or earbuds and exposed to loud noise at work, school or leisure, past year, by
noise source and age group, household population aged 19 to 79, Canada excluding territories, 2012 to 2015
percent
E
use with ca ution
* significa ntly different from r eference gr oup (p < 0.05 )
†
reference group
Source
: 2012 to 2013 and 2014 to 20 15 Canadian Health Measur es Surveys , combined.
80
68
37 35
13E
53*
46*
42
30
9E*
28* 27*
37
15*
4*
0
10
20
30
40
50
60
70
80
90
Audio devices with
headphones/earbuds
Amplified music Power tools Sporting/entertainment
events
Firearms
Source of loud noise at work, school or leisure
19 to 29 years†
30 to 49 years
50 to 79 years
Audio device use
mates with a CV of 16.6% to 33.3% are
agged with an E (interpret with caution).
Results
Prevalence of tinnitus
An estimated 37% of adult Canadians
(9.2 million) had experienced tinnitus
in the past year (Table 1). It was bother-
some for 7%, affecting aspects of their
lives such as sleep, concentration and
mood. Although men were more likely
than women to have tinnitus, they were
also more likely to report that it was
not bothersome. Younger individuals
aged 19 to 29 years were more likely
than individuals in the older age groups
to have experienced tinnitus in the past
year but also report that they were not
bothered by the condition.
Sources of loud noise
The higher prevalence of past-year
tinnitus at younger ages may be
partly explained by their use of audio
devices with headphones or earbuds
and exposure to loud noise from other
sources over the same time period. In
fact, 80% of adults in the youngest age
group reported using headphones or
earbuds connected to audio devices in
the past year, signicantly more than
adults aged 30 to 49 (53%) or 50 to 79
(28%) (Figure 1). The average weekly
hours of listening time were higher for
19 to 29-year-olds (6.2 hours per week)
than for the middle and older age groups,
at 2.9 hours per week and 1.4 hours per
week, respectively (Table 2). These aver-
ages include the entire population and,
therefore, account for the proportion of
the population who did not use audio
devices with headphones or earbuds in
the past year—these users contribute
zero hours to the average. However,
even when limiting the average weekly
listening hours to the subset of listeners
in each age group, younger people aver-
aged more time (7.8 hours per week) than
those aged 30 to 49 (5.5 hours per week)
or 50 to 79 (5.2 hours per week). Similar
trends were apparent for average weekly
hours at loud volume, which is dened
as a volume level that was usually at or
above three-quarters of the maximum
volume, or so loud that someone at arm’s
length would have to raise their voice to
be understood.

7
Statistics Canada, Catalogue no. 82-003-X • Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019
Tinnitus in Canada • Research Article
Table 2
Mean hours of headphone or earbud use per week, past year, by volume, selected
population and age group, household population aged 19 to 79, Canada excluding
territories, 2012 to 2015
Volume
Population
Total
Age group
19 to 29 years†30 to 49 years 50 to 79 years
Hours
95%
confidence
interval
Hours
95%
confidence
interval
Hours
95%
confidence
interval
Hours
95%
confidence
interval
from to from to from to from to
Any volume
Total population 2.9 2.5 3.4 6.2 4.8 7.6 2.9* 2.3 3.5 1.4* 1.0 1.9
Listening population 6.2 5.4 6.9 7.8 6.2 9.3 5.5* 4.4 6.5 5.2* 4.1 6.3
Loud volume
Total population 0.9 0.8 1.0 2.3 1.8 2.8 0.8* 0.6 1.1 0.3* 0.2 0.4
Listening population 1.9 1.7 2.1 2.9 2.3 3.4 1.6* 1.2 2.0 1.1* 0.6 1.6
* significantly different from reference group (p < 0.05)
† reference group
Source: 2012 to 2013 and 2014 to 2015 Canadian Health Measures Surveys, combined.
43% of individuals with arthritis reported
tinnitus, versus 35% of people without
the condition. No signicant differences
in the prevalence of tinnitus were found
between people with cardiovascular
disease, diabetes or kidney disease and
those without these chronic conditions.
Despite this, the prevalence of tinnitus
was higher (41%) among people who
reported one or more of the assessed
conditions compared with those without
any (34%). No signicant associations
were evident between BMI and tinnitus.
People exposed to smoke—directly as
a smoker or indirectly through second-
hand smoke—were more likely to report
tinnitus (42% and 43% respectively)
compared with non-smokers who were
not exposed to second-hand smoke
(34%).
Poor levels of well-being
Adults who experienced past-year tin-
nitus, particularly if it was bothersome,
were more likely than individuals
without tinnitus to report poor levels of
well-being (Figure 2). For example, sleep
was never or rarely refreshing for 30% of
people with bothersome tinnitus and 23%
of people with non-bothersome tinnitus,
signicantly more than for those without
tinnitus (17%). An overall rating of poor
or fair mental health was reported by
17% of people with bothersome tinnitus
and 10% of people with non-bother-
some tinnitus, compared with 6% of
those without tinnitus. The prevalence
of a mood disorder such as depression or
bipolar disorder was more than twice as
high for those with bothersome (19%) or
non-bothersome tinnitus (17%) than for
adults without tinnitus (8%).
Hearing loss and tinnitus
The audiometric assessment and CHMS
survey questions revealed that 60% of
Canadian adults had either hearing loss
or tinnitus (past-year), or both (Table 4).
An estimated 24% of adults had some
degree of hearing loss in one or both ears
with no tinnitus, 22% had tinnitus only
and 15% experienced both conditions.
People who experienced both hearing
loss and tinnitus were twice as likely
to use hearing aids (11%) as those with
hearing loss alone (5%).
Discussion
This study examined the prevalence of
past-year tinnitus and factors associated
with the condition among a nationally
representative sample of adults aged 19
to 79; an estimated 37% of the adult
population had tinnitus in the past year,
and 7% reported that the condition
was bothersome. McCormack et al.26
reviewed 39 studies—none of which
were from Canada—and reported preva-
lence estimates of tinnitus that varied
considerably, ranging from 5% to 43%
for current tinnitus and 3% to 31% for
bothersome tinnitus. They concluded
that comparisons were hampered by the
absence of standard criteria and den-
itions of tinnitus as well as by different
survey questions, response categories,
time frames, age groups and survey meth-
odologies. Prevalence estimates from
the current study are within the ranges
reported by McCormack et al.,26 albeit on
the upper end for past-year tinnitus and
on the lower end for bothersome tinnitus.
According to this study’s bivariate
analysis, men were more likely than
women to have experienced tinnitus,
which is consistent with some,15,26,27
but not all10,28,29 reports. This difference
was no longer signicant when noise
exposure was taken into account. Men are
In addition to the use of audio devices,
the younger cohort was more likely than
others to be exposed at work, or school,
or during leisure time to loud, amplied
music that occurs at concerts, nightclubs
and other venues as well as to loud noise
from rearms (Figure 1). The younger
cohort was also more likely than indi-
viduals aged 50 to 79 to report loud
noise exposure from sporting and enter-
tainment events such as hockey games.
Overall, 85% (95% CI: 82 to 87) of men
and 70% (95% CI: 68 to 72) of women
were exposed to one or more sources of
loud noise. When this noise exposure
was accounted for in a logistic regression
model, the difference between men and
women in past-year tinnitus presented
in the bivariate analysis (Table 1) was
no longer evident. Initially, the odds of
men experiencing past-year tinnitus were
higher than women (1.26, 95% CI: 1.02
to 1.56). However, when exposure to one
or more sources of noise was added to
the model, the odds of past-year tinnitus
were no longer signicant (1.17, 95% CI:
0.96 to 1.42).
Risk factors
Among people with high blood pressure
or currently taking medication to control
their blood pressure, 42% had experi-
enced tinnitus in the past year, compared
with 35% of those without high blood
pressure (Table 3). Arthritis was also
signicantly associated with tinnitus:

8Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019 • Statistics Canada, Catalogue no. 82-003-X
Tinnitus in Canada • Research Article
more likely than women to work in noisy
environments and for longer durations,17
both of which have been associated with
higher rates of tinnitus.16,27
Men were more likely than women
to report that they were not bothered by
their tinnitus, in that it did not affect their
sleep or concentration, for example. This
highlights two components of tinnitus:
the presence of the condition itself, an
emotionally neutral assessment related
to the awareness and duration of tinnitus,
and the individual reaction to the condi-
tion, the level of distress signifying the
subjective feelings of suffering that result
from the tinnitus.30 Earlier work shows
that women are more likely to report
sleep interference and feeling tired or ill
because of tinnitus.31 Vanneste et al.32
reported that women were more likely
than men to experience a depressive state
even when there were no differences in
tinnitus intensity and tinnitus-related dis-
tress and emphasized the importance of
considering sex differences in tinnitus
research.
Studies consistently report that the
prevalence of tinnitus increases with
increasing age.6,10,16,26-28 This is to be
expected with no cure for tinnitus and
more potential life-years of exposure
to noise, medications, trauma and other
precipitators. However, data from this
study revealed that the younger cohort
of Canadians (aged 19 to 29 years) was
signicantly more likely than older
adults to have tinnitus, consistent with
ndings of Nondahl et al.33 This may
reect more noise exposure at younger
ages with changes in technology and
individual behaviours, such as the
development and use of audio devices
with headphones or earbuds, as shown
in this study, in addition to increasingly
noisy environments.34-37 Alternatively,
it could reect a greater awareness and
reporting of the condition at younger
ages.33 The higher prevalence of tinnitus
at younger ages suggests that population
estimates of this condition will increase
in the future. Although younger people
were more likely to have tinnitus, they
were also more likely to report that it was
not bothersome. This is consistent with
Kim et al.29 who found that older age was
associated with an increase in tinnitus
that was annoying.
Tinnitus is a symptom rather than a
disease in itself.7 Although the events
and conditions precipitating the onset of
tinnitus often cannot be identied,6 there
are a variety of recognized risk factors,
including those that are otological, neuro-
logical, cardiovascular, trauma-related
and medication-related.6,7 The association
between high blood pressure and tinnitus
found in this study has been seen else-
where.16,28 Arthritis has been identied as
Table 3
Prevalence of tinnitus, past year,
by associated factors, household
population aged 19 to 79, Canada
excluding territories, 2012 to 2015
Characteristics %
95%
confidence
interval
from to
Chronic conditions
High blood pressure
Yes 41.7* 36.0 47.6
No†35.0 32.1 38.1
Cardiovascular disease
Yes 41.6 33.1 50.6
No†36.4 33.5 39.3
Diabetes
Yes 39.5 33.2 46.1
No†36.4 33.2 39.6
Kidney dysfunction or disease
Yes 35.0E22.8 49.5
No†36.6 33.6 39.7
Arthritis
Yes 42.9* 35.4 50.8
No†35.3 32.5 38.1
One or more comorbid
conditions
Yes 40.8* 35.8 46.0
No†34.1 31.5 36.9
Body mass index (kg/m2)
Underweight (<18.50) 28.7E15.0 48.0
Normal (18.50 to 24.99)†36.3 32.4 40.4
Overweight (25.00 to 29.99) 34.8 31.1 38.6
Obese Class I (30.00 to 34.99) 37.1 30.7 44.0
Obese Class II and III (≥ 35.00) 42.7 34.3 51.5
Exposure to smoke
Smoker (daily/occasional) 42.1* 36.4 47.9
Non-smoker (former/never)
Second-hand smoke exposure 43.2* 35.2 51.6
No second-hand smoke
exposure†34.0 31.3 36.8
E use with caution
* significantly different from reference group (p < 0.05)
† reference category
Source: 2012 to 2013 and 2014 to 2015 Canadian Health
Measures Surveys, combined.
a risk factor for tinnitus,7,29,33,38,39 which is
consistent with results from the CHMS.
Medications to manage pain and inam-
mation may be ototoxic and precipitate
tinnitus.10,39 Associations between tin-
nitus and obesity and diabetes that are
seen elsewhere were not evident in this
study.16,28 Nor was there an association
between being underweight and having
tinnitus, as Lee et al.40 found, although
their study population was restricted to
premenopausal women. Smoking, which
is a risk factor for cardiovascular disease,
is also associated with tinnitus.4,16 The
current study added a dimension with
the nding that non-smokers exposed to
second-hand smoke were just as likely to
have tinnitus as smokers.
Data from this study show that indi-
viduals with tinnitus were more likely
than those without the condition to report
poor levels of mental and emotional
well-being. Associations of tinnitus
with mood disorders and diminished
well-being are consistent with earlier
work.28,39,41-43 A review by Ziai et al.41
reported strong associations of tinnitus
with depression and anxiety. In addi-
tion to these disorders, Bhatt et al.42
established that individuals with tinnitus
averaged fewer hours of sleep per night.
Nondahl et al.39 reported depressive
symptoms as a risk factor for tinnitus
but acknowledged that the opposite or
a bi-directional relationship may exist.
Temporal data indicate that the presence
of tinnitus can lead to psychological dis-
tress.43 Personality traits including more
pronounced reactions to stress and lower
social closeness may play a role in the
distress associated with tinnitus, when
individuals’ attention is focussed on the
condition interfering with positive adap-
tation.44 Although reports of high daily
stress and a weak sense of community
belonging are associated with tinnitus in
the CHMS, it is not possible to establish
whether these feelings contributed to or
resulted from the tinnitus. Regardless of
the direction between tinnitus and dimin-
ished well-being, there is agreement that
people suffering from this condition
could benet from early intervention,
mental health screening and appropriate
treatment.9,43

9
Statistics Canada, Catalogue no. 82-003-X • Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019
Tinnitus in Canada • Research Article
Table 4
Distribution of tinnitus, past year, and/or hearing loss, and prevalence of hearing aid
use, household population aged 19 to 79, Canada excluding territories, 2012 to 2015
Condition
Distribution of hearing loss
and tinnitus Prevalence of hearing aid use
Number
‘000 %
95%
confidence
interval Number
‘000 %
95%
confidence
interval
from to from to
Total ... 100.0 ... ... 664 7.2 6.0 8.7
Hearing loss and tinnitus 3,490 14.5 12.7 16.5 387E11.1* 8.0 15.1
Hearing loss only†5,680 23.5 21.8 25.4 277 4.9 3.9 6.1
Tinnitus only 5,277 21.9 19.9 24.0 ... ... ... ...
No hearing loss or tinnitus 9,688 40.1 38.0 42.3 ... ... ... ...
... not applicable
E use with caution
* significantly different from reference group (p < 0.05)
† reference group
Source: 2012 to 2013 and 2014 to 2015 Canadian Health Measures Surveys, combined.
Figure 2
Prevalence of mental, emotional and quality of life characteristics by past year tinnitus status, household population aged 19 to 79,
Canada excluding territories, 2012 to 2015
percent
E
use with ca ution
* significa ntly different from b othersome tinnitus ( p < 0.05)
†
significantly different from non-bothersome tinnitus (p < 0.05)
Source
: 2012 to 2013 and 2014 to 20 15 Canadian Health Measur es Surveys , combined.
17E
12E
19E
45
33
30E
10
8E
17
37
29
23
6*†6
8*†
33*
25†
17*†
0
5
10
15
20
25
30
35
40
45
50
Poor self-reported
mental health Poor quality of life Mood disorder Weak sense of
community belonging High daily stress Poor qualit y sleep
Mental, emotional or quality of life characteristic
Bothersome tinnitus
Non-bothersome tinnitus
No tinnitus
Hearing loss is a risk factor for tin-
nitus,28,43 and the use of hearing aids is
often an effective tool to help manage
this condition.1,14 Data from the CHMS
may be evidence of this nding, given
that people with hearing loss and tinnitus
were twice as likely to use hearing aids
as those with hearing loss alone. Hearing
loss management (such as hearing aids,
combination instruments and cochlear
implants), sound-based therapy (for
example, tinnitus retraining therapy,
progressive tinnitus management and
tinnitus activities treatment), behavioural
interventions (cognitive behavioural
therapy, acceptance and commitment
therapy, etc.), and educational coun-
selling are all effective interventions
depending on the clinical picture of the
tinnitus patient.1,2,15 Alternatively, the
combination of tinnitus and hearing loss
may have increased help-seeking behav-
iours and the subsequent use of hearing
aids.
Results from this study indicate that
one in every ve Canadian adults has
tinnitus with no measured hearing loss.
However, the presence of tinnitus may
indicate that a subclinical level of damage
has already occurred45 and signals future
trends in hearing loss among Canadians.
Strengths and limitations
A strength of this study is the large
sample representative of the Canadian
population. In addition to questions about
tinnitus, the CHMS includes self-reports
on noise exposure and objective measure-
ments of hearing loss. The study clearly
showed the negative association between
portable personal sound listening devices
and the hearing health of younger adults.
There is no distinction between sub-
jective and objective tinnitus in the
CHMS, nor between idiopathic tinnitus
and tinnitus secondary to an underlying
condition. The CHMS does not include
other sound sensitivity disorders that

10 Health Reports, Vol. 30, no. 3, pp. 3-11, March 2019 • Statistics Canada, Catalogue no. 82-003-X
Tinnitus in Canada • Research Article
accompany tinnitus, such as hyperacusis,
misophonia and phonophobia.
Clinicians focus on bothersome, per-
sistent (lasting six months or longer)
tinnitus. Individuals with persistent tin-
nitus could not be adequately identied,
and, therefore, the classication of tin-
nitus was limited to bothersome or not.
The CHMS is a cross-sectional
survey. It is not possible to establish tem-
poral order between tinnitus and chronic
conditions, smoking status and BMI.
The lower estimate of past-year tinnitus
among older Canadians could reect
cohort differences or indicate that tin-
nitus resolved over time.
Conclusion
Tinnitus is a common and potentially
distressing condition. Although there
is no medical cure for tinnitus, there
are many management protocols that
have been proven effective at reducing
the negative effects of tinnitus and
improving overall quality of life. Noise
exposure—particularly through the use
of headphones or earbuds—may explain
the higher prevalence of tinnitus among
younger adults compared with the older
cohorts and may indicate areas on which
to focus education and behaviour change.
Canadians could benet from greater
awareness of tinnitus, prevention strat-
egies and management options. The high
prevalence of tinnitus and potentially
life-altering consequences indicate that it
is an important public health problem. ■
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