Article  |   December 2007
The Association Between Tinnitus and Posttraumatic Stress Disorder
Author Affiliations & Notes
  • Marc A. Fagelson
    East Tennessee State University, Johnson City, and James H. Quillen Veterans Affairs Medical Center Tinnitus Clinic, Mountain Home, TN
  • Contact author: Marc A. Fagelson, Department of Communicative Disorders, East Tennessee State University, Box 70643, Johnson City, TN 37614. E-mail: fagelson@etsu.edu.
Article Information
Hearing Disorders
Article   |   December 2007
The Association Between Tinnitus and Posttraumatic Stress Disorder
American Journal of Audiology, December 2007, Vol. 16, 107-117. doi:10.1044/1059-0889(2007/015)
History: Received January 30, 2007 , Accepted April 30, 2007
American Journal of Audiology, December 2007, Vol. 16, 107-117. doi:10.1044/1059-0889(2007/015)
History: Received January 30, 2007; Accepted April 30, 2007

Purpose: Posttraumatic stress disorder (PTSD) affects nearly 10% of the population, a prevalence comparable with that of tinnitus. Similarities between the way PTSD and tinnitus influence auditory behaviors include exaggerated startle responses and decreased loudness tolerance. Tinnitus loudness is often exacerbated by sounds that trigger PTSD-related anxiety. This report addresses physical and psychological relations between PTSD and tinnitus.

Method: A chart review of veterans seen over a 4-year period for tinnitus services was conducted. Case history and self-assessments of tinnitus handicap were examined in all patients. A review of the literature related to triggers and effects of PTSD was conducted to explore potential consequences related to the presence of PTSD in the Veterans Affairs Medical Center (VAMC) tinnitus population.

Results: Chart review confirmed that 34% of the first 300 patients enrolled in the VAMC Tinnitus Clinic also carried a diagnosis of PTSD. Patient reports citing tinnitus severity, suddenness of tinnitus onset, sound-tolerance problems, and sound-triggered exacerbation of tinnitus were more common for patients with a PTSD diagnosis than patients with tinnitus only.

Conclusions: Several neural mechanisms linked to both tinnitus and PTSD affect auditory behaviors. Audiologists should be aware that patients with tinnitus and PTSD will require test protocols and referrals that address these powerful responses.

Acknowledgments
Portions of this work were presented at the 12th Annual Conference on the Management of the Tinnitus Patient, Iowa City, IA, September 2004. I would like to acknowledge Dr. Richard H. Wilson for comments and guidance throughout the preparation of the article. I would also like to thank Dr. John Auerbach of the Psychology Section of the James H. Quillen Veterans Affairs Medical Center, who recommended source material for the study of posttraumatic stress disorder (PTSD) and provided valuable information related to the PTSD clinic’s function.
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