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Improving Sensitivity of Tinnitus Screening in Hearing Conservation Programs.
Michele L Spencer1,2, LaGuinn P Sherlock1,3, Benjamin M Sheffield1,3
1Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States.
Military Medicine
|January 28, 2026
Summary
A modified tinnitus screening question accurately identifies U.S. military Service Members needing audiology referrals. This improved screening helps differentiate bothersome tinnitus from transient ear noise, optimizing care.
Area of Science:
- Audiology and Hearing Science
- Military Health
- Clinical Triage
Background:
- Tinnitus is common in U.S. military Service Members (SMs).
- Current Department of Defense (DOD) Hearing Conservation Program (HCP) screening questions may not differentiate transient ear noise from clinically significant tinnitus.
- A modified screening question incorporating symptom duration, frequency, and impact was developed by the Department of Veterans Affairs (VA)/DOD Tinnitus Working Group.
Purpose of the Study:
- To evaluate if the modified VA/DOD tinnitus screening question improves the identification of SMs requiring referral for tinnitus evaluation and management.
- To assess the alignment of responses to both screening questions with validated tinnitus questionnaires, referral preferences, and diagnostic outcomes.
Main Methods:
- An observational study of 4,922 SMs undergoing routine HCP visits.
- Participants completed the current screening question (Question A) and the modified VA/DOD question (Question B).
- Validated questionnaires (Tinnitus and Hearing Survey-Tinnitus Subscale [THS-T], Tinnitus Functional Index [TFI]) and audiological evaluations were used for further assessment.
Main Results:
- 56% of SMs reporting mild bother on Question A answered "no" to the more specific Question B, suggesting transient ear noise.
- Question B demonstrated high sensitivity (98%) and specificity (94%) for identifying clinically significant tinnitus requiring referral.
- SMs requesting referral showed significantly higher THS-T and TFI scores, validating the self-reported impact.
Conclusions:
- The modified tinnitus screening question enhances the accuracy of identifying SMs who need audiology referrals for tinnitus.
- This improved triage reduces unnecessary clinical workload and optimizes resource allocation.
- Findings support adopting the modified question, potentially alongside brief validated questionnaires and self-reported referral interest, to refine tinnitus management pathways.
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