title: Generational differences in the reporting of tinnitus.
abstract: OBJECTIVE
  Recent research suggests that hearing impairment is declining among older adults compared with earlier generations of the same age. Tinnitus is often associated with hearing impairment, so one might hypothesize that the prevalence of tinnitus is declining in a similar manner. The purpose of this study was to use multigenerational data with repeated measures to determine whether the prevalence of tinnitus is declining among more recent generations.
  
  
  METHODS
  Using data from the Epidemiology of Hearing Loss Study (1993-1995, 1998-2000, 2003-2005, and 2009-2010) and the Beaver Dam Offspring Study (2005-2008), the authors examined birth cohort patterns in the report of tinnitus for adults aged 45 years and older (n =12,689 observations from 5764 participants). Participants were classified as having tinnitus if they reported tinnitus in the past year of at least moderate severity or that caused difficulty falling asleep. A low-frequency (500, 1000, and 2000 Hz) and high-frequency (3000, 4000, 6000, and 8000 Hz) pure tone average from the worse ear was used to summarize hearing status. Other potential risk factors for tinnitus were also explored to determine if changes in the prevalence of these factors over time could explain any observed birth cohort differences in the prevalence of tinnitus. These included the following: education, history of head injury, history of doctor-diagnosed ear infections, history of cardiovascular disease (myocardial infarction, stroke, or angina), current noisy job, longest-held job, target shooting in the past year, number of concerts ever attended, alcohol use in the past year, doctor diagnosis of arthritis, current aspirin use, regular exercise, and consulting with a physician in the past year about any hearing/ear problem. Birth cohort effects were modeled with alternating logistic regression models which use generalized estimating equations to adjust for correlation among repeated measurements over time that are nested within families.
  
  
  RESULTS
  The report of tinnitus tended to increase with more recent birth cohorts compared with earlier birth cohorts. For example, at ages 55 to 59 years, 7.6% of participants born between 1935 and 1939 reported tinnitus, compared with 11.0% of those born in 1940 to 1944, 13.6% of those born between 1945 and 1949, and 17.5% of those born between 1950 and 1954. Similarly, at ages 65 to 69 years, 7.9% of participants born between 1925 and 1929 reported tinnitus, compared with 10.0% of those born between 1930 and 1934, 11.9% of those born between 1935 and 1939, and 13.7% of those born between 1940 and 1944. Final alternating logistic regression model results indicated that, on average, after adjusting for age and other factors, participants in a given generation were significantly more likely to report tinnitus than participants from a generation 20 years earlier (odds ratio = 1.78, 95% confidence interval = 1.44, 2.21).
  
  
  CONCLUSIONS
  Increased reports of tinnitus may reflect increased prevalence of symptoms, increased awareness of symptoms, or higher health expectations among more recent generations of adults. Regardless of the reasons, the increasing prevalence of tinnitus suggests that health care providers may see an increased number of patients bothered by this common but little understood symptom.
authors.affiliation: Department of Ophthalmology & Visual Sciences, University of Wisconsin, Madison, Wisconsin 53726, USA. nondahl@episense.wisc.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Nondahl
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Cruickshanks
authors.forename: Guan-Hua
authors.initials: GH
authors.lastname: Huang
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Ted S
authors.initials: TS
authors.lastname: Tweed
authors.forename: Weihai
authors.initials: W
authors.lastname: Zhan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015988:Cohort Effect; D015331:Cohort Studies; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D014012:Tinnitus / Q000453:epidemiology*