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Associations Between Traumatic Brain Injury and Severity of Tinnitus-Related Functional Impairment Among US Military
Laura Coco1, Elizabeth R Hooker, Tess A Gilbert
1School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California (Dr Coco); VA Health Services Research & Development Service Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon (Drs Coco, O'Neil, and Carlson, Ms Hooker and Gilbert, and Mr Prewitt); Oregon Health & Science University-Portland State University School of Public Health, Portland (Ms Hooker, Mr Prewitt, and Drs Reavis, Clark, Zaugg, and Carlson); VA Rehabilitation Research & Development Service, National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, Oregon (Drs Reavis, Henry, and Carlson); and Departments of Medical Informatics and Clinical Epidemiology (Drs O'Neil and Clark); and Otolaryngology-Head and Neck Surgery (Dr Henry), Oregon Health & Science University, Portland.
Objective:
To describe associations between a history of traumatic brain injury (TBI) and the severity of tinnitus-related functional impairment among a national, stratified random sample of veterans diagnosed with tinnitus by the Department of Veterans Affairs (VA) healthcare system.
Setting:
A multimodal (mailed and internet) survey administered in 2018. Participants: VA healthcare-using veterans diagnosed with tinnitus; veterans with comorbid TBI diagnosis were oversampled.
Design:
A population-based survey.
Main Measures:
TBI history was assessed using International Classification of Diseases (ICD) diagnosis codes in veterans' VA electronic health records. The severity of participants' overall tinnitus-related functional impairment was measured using the Tinnitus Functional Index. Population prevalence and 95% confidence intervals (CIs) were estimated using inverse probability weights accounting for sample stratification and survey nonresponse. Veterans' relative risk ratios of very severe or moderate/severe tinnitus-related functional impairment, versus none/mild impairment, were estimated by TBI history using bivariable and multivariable multinomial logistic regression.
Results:
The population prevalence of TBI was 5.6% (95% CI: 4.8-6.4) among veterans diagnosed with tinnitus. Veterans with a TBI diagnosis, compared with those without a TBI diagnosis, had 3.6 times greater likelihood of rating their tinnitus-related impairment as very severe (95% CI: 2.1-6.3), and 1.5 times greater likelihood of rating their impairment as moderate/severe (95% CI: 1.0-2.4), versus none/mild.
Conclusions:
These findings suggest an important role of TBI in the severity of tinnitus-related functional impairment among veterans. This knowledge can help inform the integration of tinnitus management services into the care received by veterans with TBI.
