A study on the epidemiology of tinnitus in the United Kingdom

Figures & data

Table 1 Distribution of patient characteristics and lifestyle factors in patients with tinnitus and their matched controls

	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)
Sex
Male	53,874 (49.1)	53,874 (49.1)	NA	NA
Female	55,909 (50.9)	55,909 (50.9)	NA	NA
Age (years)
<20	1097 (1.0)	1100 (1.0)	NA	NA
20–29	7118 (6.5)	7109 (6.5)	NA	NA
30–39	11,757 (10.7)	11,757 (10.7)	NA	NA
40–49	19,454 (17.7)	19,476 (17.7)	NA	NA
50–59	26,247 (23.9)	26,233 (23.9)	NA	NA
60–69	24,097 (22.0)	24,122 (22.0)	NA	NA
70–79	13,860 (12.6)	13,823 (12.6)	NA	NA
≥80	6153 (5.6)	6163 (5.6)	NA	NA
BMI (kg/m^2)
12.0–18.4	1561 (1.4)	1634 (1.5)	0.88 (0.82–0.95)	0.91 (0.84–0.97)
18.5–24.9	36,055 (32.8)	33,901 (30.9)	1.00 (reference)	1.00 (reference)
25.0–29.9	36,138 (32.9)	32,981 (30.0)	1.04 (1.02–1.06)	1.02 (1.00–1.04)
30.0–60.0	21,853 (19.9)	22,157 (20.2)	0.94 (0.91–0.96)	0.91 (0.89–0,94)
30.0–34.9	14,876 (13.6)	14,847 (13.5)	0.95 (0.93–0.96)	0.93 (0.90–0.96)
35.0–39.9	4794 (4.4)	4917 (4.5)	0.93 (0.89–0.97)	0.90 (0.86–0.94)
40.0–60.0	2183 (2.0)	2393 (2.2)	0.87 (0.82–0.92)	0.83 (0.79–0.89)
Unknown	14,176 (12.9)	19,110 (17.4)	0.64 (0.62–0.66)	0.78 (0.75–0.80)
Smoking status
Non-smoker	53,513 (48.7)	50,517 (46.0)	1.00 (reference)	1.00 (reference)
Ex-smoker	32,952 (30.0)	29,321 (26.7)	1.08 (1.06–1.10)	1.08 (1.06–1.10)
Current smoker	18,334 (16.7)	21,904 (20.0)	0.78 (0.76–0.79)	0.78 (0.76–0.80)
Unknown	4984 (4.5)	8041 (7.3)	0.51 (0.49–0.53)	0.68 (0.65–0.71)
Alcohol consumption
Non-drinker	17,399 (15.9)	16,062 (14.6)	1.00 (reference)	1.00 (reference)
Ex-drinker	2308 (2.1)	2005 (1.8)	1.07 (1.00–1.14)	1.09 (1.03–1.17)
Current drinker (units/week)
1–9	29,403 (26.8)	27,743 (25.3)	0.97 (0.95–1.00)	0.96 (0.93–0.98)
10–19	12,159 (11.1)	11,971 (10.9)	0.93 (0.89–0.96)	0.91 (0.88–0.94)
≥20	9132 (8.3)	9462 (8.6)	0.87 (0.84–0.90)	0.88 (0.84–0.91)
unknown	28,443 (25.9)	27,281 (24.9)	0.95 (0.93–0.98)	0.95 (0.92–0.98)
Unknown	10,939 (10.0)	15,259 (13.9)	0.59 (0.57–0.62)	0.74 (0.71–0.77)

Notes: ^aAdjusted for BMI category, smoking status, alcohol consumption.

Abbreviations: BMI, body mass index; CI, confidence interval; NA, not applicable; OR, odds ratio.

Figure 1 Age- and sex-specific crude incidence rates (IRs) of tinnitus first-time diagnoses in the United Kingdom from 2000 to 2016.

Figure 2 Sex-specific and age-standardised incidence rates (ASRs) of tinnitus first-time diagnoses in the United Kingdom from 2000 to 2016.

Note: Standard population from Eurostat.²⁷

Table 2 Distribution of comorbidities in patients with tinnitus and their matched controls: internal diseases and neurological/psychological disorders

	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)
Neurological/psychological disorders
Insomnia	14,944 (13.6)	11,043 (10.1)	1.46 (1.42–1.50)	1.45 (1.41–1.49)
Anxiety	22,872 (20.8)	17,839 (16.3)	1.39 (1.36–1.42)	1.39 (1.35–1.42)
Depression	22,421 (20.4)	18,363 (16.7)	1.30 (1.27–1.33)	1.31 (1.28–1.34)
Seizure/Epilepsy	2393 (2.2)	2366 (2.2)	1.01 (0.96–1.07)	1.01 (0.96–1.08)
Multiple Sclerosis	324 (0.3)	369 (0.3)	0.88 (0.76–1.02)	0.89 (0.76–1.03)
Schizophrenia	623 (0.6)	831 (0.8)	0.75 (0.67–0.83)	0.76 (0.69–0.85)
Parkinson Disease	256 (0.2)	411 (0.4)	0.62 (0.53–0.73)	0.63 (0.54–0.74)
Dementia	282 (0.3)	660 (0.6)	0.42 (0.36–0.48)	0.42 (0.37–0.49)
Cardiovascular disorders
Arrhythmia	6374 (5.8)	5304 (4.8)	1.23 (1.18–1.28)	1.19 (1.14–1.24)
Hypertension	25,988 (23.7)	25,609 (23.3)	1.02 (1.00–1.05)	0.98 (0.96–1.00)
Myocardial infarction	2935 (2.7)	2974 (2.7)	0.99 (0.94–1.04)	0.95 (0.90–1.00)
Congestive heart failure	1505 (1.4)	1593 (1.5)	0.94 (0.88–1.01)	0.92 (0.85–0.99)
Stroke/TIA	3385 (3.1)	3735 (3.4)	0.90 (0.86–0.94)	0.88 (0.84–0.93)
Metabolic disorders
Hyperlipidemia	12,081 (11.0)	10,595 (9.7)	1.18 (1.15–1.22)	1.14 (1.11–1.18)
Hypothyroidism	6225 (5.7)	5500 (5.0)	1.15 (1.10–1.19)	1.13 (1.08–1.17)
Hyperthyroidism	1523 (1.4)	1363 (1.2)	1.12 (1.04–1.21)	1.11 (1.03–1.20)
Diabetes mellitus	6915 (6.3)	7626 (7.0)	0.90 (0.87–0.93)	0.85 (0.83–0.89)
Other disorders
Irritable bowel syndrome	11,008 (10.0)	7288 (6.6)	1.59 (1.54–1.65)	1.56 (1.51–1.61)
Fibromyalgia	1588 (1.5)	1053 (1.0)	1.54 (1.42–1.67)	1.53 (1.41–1.66)
Asthma	16,630 (15.2)	14,842 (13.5)	1.15 (1.12–1.18)	1.11 (1.08–1.14)
Rheumatoid Arthritis	1479 (1.4)	1336 (1.2)	1.11 (1.03–1.20)	1.10 (1.02–1.19)
COPD	2848 (2.6)	3062 (2.8)	0.93 (0.88–0.98)	0.95 (0.90–1.00)

Notes: Comorbidities listed according to their odds ratios in decreasing order. ^aAdjusted for BMI category, smoking status, alcohol consumption.

Abbreviations: CI, confidence interval; COPD, Chronic obstructive pulmonary disease; OR, odds ratio; TIA, transient ischemic attack.

Table 3 Distribution of comorbidities in patients with tinnitus and their matched controls: otological and vestibular disorders

	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)
Sensorineural Hearing Loss
≤30 days prior to (includigng) the ID	618 (0.6)	< 5^b (0.0)	156.99 (58.81–419.08)	161.70 (60.56–431.73)
31 to 360 days prior to the ID	179 (0.2)	60 (0.1)	3.18 (2.36–4.28)	3.10 (2.29–4.18)
>360 days prior to the ID	1142 (1.0)	701 (0.6)	1.68 (1.53–1.85)	1.68 (1.53–1.85)
Acute vestibular neuronitis
≤30 days prior to (includigng) the ID	37 (0.0)	< 5^b (0.0)	36.15 (5.07–257.83)	34.14 (4.79–243.60)
31 to 360 days prior to the ID	68 (0.1)	27 (0.0)	2.58 (1.64–4.05)	2.37 (1.50–3.73)
>360 days prior to the ID	390 (0.4)	236 (0.2)	1.66 (1.41–1.95)	1.63 (1.39–1.92)
Otitis media
≤30 days prior to (includigng) the ID	1114 (1.0)	51 (0.1)	22.91 (17.30–30.32)	22.82 (17.23–30.22)
31 to 360 days prior to the ID	1753 (1.6)	489 (0.5)	3.82 (3.45–4.23)	3.81 (3.44–4.22)
>360 days prior to the ID	11,552 (10.5)	9483 (8.6)	1.33 (1.29–1.37)	1.31 (1.27–1.36)
Labyrinthitis
≤30 days prior to (includigng) the ID	408 (0.4)	20 (0.0)	20.90 (13.34–32.73)	20.19 (12.88–31.65)
31 to 360 days prior to the ID	867 (0.8)	277 (0.3)	3.26 (2.85–3.74)	3.19 (2.78–3.66)
>360 days prior to the ID	4338 (4.0)	3014 (2.8)	1.49 (1.42–1.57)	1.46 (1.40–1.54)
Conductive Hearing Loss
≤30 days prior to (includigng) the ID	52 (0.1)	< 5^b (0.0)	17.32 (5.41–55.42)	19.51 (6.07–62.74)
31 to 360 days prior to the ID	29 (0.0)	< 5^b (0.0)	7.25 (2.55–20.62)	7.23 (2.53–20.67)
>360 days prior to the ID	290 (0.3)	229 (0.2)	1.27 (1.07–1.51)	1.25 (1.05–1.48)
Benign positional vertigo
≤30 days prior to (includigng) the ID	462 (0.4)	37 (0.0)	13.11 (9.37–18.34)	12.94 (9.24–18.11)
31 to 360 days prior to the ID	960 (0.9)	398 (0.4)	2.56 (2.28–2.89)	2.48 (2.20–2.80)
>360 days prior to the ID	3488 (3.2)	2294 (2.1)	1.60 (1.51–1.69)	1.56 (1.48–1.65)
Cerumen
≤30 days prior to (includigng) the ID	4249 (3.9)	407 (0.4)	11.74 (10.58–13.04)	11.56 (10.41–12.83)
31 to 360 days prior to the ID	6680 (6.1)	3512 (3.2)	2.17 (2.07–2.26)	2.12 (2.03–2.21)
>360 days prior to the ID	14,702 (13.4)	14,513 (13.2)	1.13 (1.10–1.16)	1.11 (1.08–1.14)
Otitis externa
≤30 days prior to (includigng) the ID	1875 (1.7)	203 (0.2)	9.88 (8.54–11.44)	9.87 (8.52–11.43)
31 to 360 days prior to the ID	3575 (3.3)	1506 (1.4)	2.55 (2.40–2.71)	2.54 (2.39–2.70)
>360 days prior to the ID	13,171 (12.0)	11,085 (10.1)	1.28 (1.24–1.31)	1.26 (1.23–1.30)

Notes: ^aAdjusted for BMI category, smoking status, alcohol consumption. ^bFor confidentiality reasons, we do not provide the number of patients in categories containing less than five patients.

Abbreviations: CI, confidence interval; ID, index date; NA, not available; OR, odds ratio.

Table 4 Distribution of comorbidities in patients with tinnitus and their matched controls: head and neck disorders

	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)
Tension-type headache
≤30 days prior to (includigng) the ID	104 (0.1)	9 (0.0)	11.72 (5.93–23.17)	11.71 (5.92–23.19)
31 to 360 days prior to the ID	359 (0.3)	145 (0.1)	2.53 (2.09–3.07)	2.52 (2.07–3.06)
>360 days prior to the ID	3331 (3.0)	2176 (2.0)	1.58 (1.49–1.67)	1.54 (1.46–1.63)
Concussion
≤30 days prior to (includigng) the ID	25 (0.0)	<5^b (0.0)	8.31 (2.51–27.47)	8.45 (2.54–28.05)
31 to 360 days prior to the ID	39 (0.0)	19 (0.0)	2.05 (1.19–3.55)	2.10 (1.21–3.66)
>360 days prior to the ID	539 (0.5)	497 (0.5)	1.09 (0.96–1.23)	1.09 (0.96–1.23)
Temporomandibular joint disorders
≤30 days prior to (includigng) the ID	115 (0.1)	17 (0.0)	6.84 (4.11–11.38)	6.63 (3.98–11.06)
31 to 360 days prior to the ID	308 (0.3)	144 (0.1)	2.17 (1.78–2.64)	2.09 (1.71–2.56)
>360 days prior to the ID	2323 (2.1)	1501 (1.4)	1.58 (1.48–1.68)	1.54 (1.44–1.64)
Whiplash
≤30 days prior to (includigng) the ID	86 (0.1)	15 (0.0)	5.80 (3.35–10.04)	5.39 (3.11–9.34)
31 to 360 days prior to the ID	345 (0.3)	232 (0.2)	1.51 (1.27–1.78)	1.48 (1.25–1.75)
>360 days prior to the ID	4517 (4.1)	3778 (3.4)	1.21 (1.16–1.27)	1.20 (1.15–1.25)
Cervicalgia
≤30 days prior to (includigng) the ID	985 (0.9)	210 (0.2)	5.17 (4.45–6.01)	5.04 (4.33–5.86)
31 to 360 days prior to the ID	3000 (2.7)	1740 (1.6)	1.89 (1.78–2.01)	1.82 (1.72–1.94)
>360 days prior to the ID	18,075 (16.5)	13,399 (12.2)	1.50 (1.46–1.54)	1.47 (1.44–1.51)
Migraine
≤30 days prior to (includigng) the ID	346 (0.3)	80 (0.1)	4.54 (3.56–5.79)	4.38 (3.43–5.60)
31 to 360 days prior to the ID	1045 (1.0)	603 (0.6)	1.83 (1.65–2.02)	1.77 (1.59–1.95)
>360 days prior to the ID	9519 (8.7)	7160 (6.5)	1.39 (1.35–1.44)	1.37 (1.32–1.41)
Cranial nerve disorders
≤30 days prior to (includigng) the ID	90 (0.1)	21 (0.0)	4.32 (2.69–6.95)	4.33 (2.69–6.98)
31 to 360 days prior to the ID	342 (0.3)	177 (0.2)	1.95 (1.63–2.35)	1.90 (1.58–2.29)
>360 days prior to the ID	2286 (2.1)	1772 (1.6)	1.30 (1.22–1.39)	1.30 (1.22–1.39)

Notes: ^aAdjusted for BMI category, smoking status, alcohol consumption. ^bFor confidentiality reasons, we do not provide the number of patients in categories containing less than five patients.

Abbreviations: CI, confidence interval; ID, index date; NA, not available; OR, odds ratio.

Table S1 Incidence rates of tinnitus diagnosed in the UK between 2000 and 2016

	Number of PY at risk	Number of tinnitus patients	crude IR per 10,000 PY (95% CI)	ASR^a per 10,000 PY (95% CI)
Overall	4,52,48,312	1,09,783	24.3 (24.1–24.4)	25.0 (24.6–25.5)
By sex
Men	2,18,41,921	53,874	24.7 (24.5–24.9)	25.7 (25.0–26.4)
Women	2,34,06,391	55,909	23.9 (23.7–24.1)	24.7 (24.0–25.3)
By age (years)
<20	16,50,985	1,097	6.6 (6.3–7.0)	NA
20–29	73,48,559	7,118	9.7 (9.5–9.9)	NA
30–39	78,78,802	11,757	14.9 (14.7–15.2)	NA
40–49	86,20,883	19,454	22.6 (22.3–22.9)	NA
50–59	75,16,334	26,247	34.9 (34.5–35.3)	NA
60–69	58,51,960	24,097	41.2 (40.7–41.7)	NA
70–79	39,82,409	13,860	34.8 (34.2–35.4)	NA
≥80	23,98,378	6,153	25.7 (25.0–26.3)	NA
By year of diagnosis
2000	25,43,654	4,646	18.3 (17.7–18.8)	19.1 (17.4–20.9)
2001	26,44,954	5,049	19.1 (18.6–19.6)	18.3 (16.7–20.0)
2002	27,28,728	5,671	20.8 (20.2–21.3)	20.0 (18.3–21.6)
2003	28,20,513	5,821	20.6 (20.1–21.2)	19.8 (18.2–21.5)
2004	29,14,236	6,541	22.4 (21.9–23.0)	21.6 (19.9–23.3)
2005	29,73,188	6,713	22.6 (22.0–23.1)	21.9 (20.2–23.5)
2006	30,16,968	7,028	23.3 (22.8–23.8)	22.6 (20.9–24.3)
2007	30,27,173	7,276	24.0 (23.5–24.6)	23.4 (21.6–25.1)
2008	30,47,487	7,775	25.5 (25.0–26.1)	24.7 (23.0–26.5)
2009	30,26,926	8,060	26.6 (26.1–27.2)	26.0 (24.2–27.9)
2010	29,78,185	7,754	26.0 (25.5–26.6)	25.4 (23.6–27.3)
2011	29,04,131	7,903	27.2 (26.6–27.8)	26.4 (24.5–28.2)
2012	28,15,439	7,591	27.0 (26.4–27.6)	26.1 (24.2–28.0)
2013	25,98,517	6,858	26.4 (25.8–27.0)	25.4 (23.5–27.4)
2014	22,81,051	6,190	27.1 (26.5–27.8)	26.0 (23.9–28.1)
2015	18,33,974	5,171	28.2 (27.4–29.0)	26.9 (24.6–29.3)
2016	10,93,189	3,736	34.2 (33.1–35.3)	32.2 (28.8–35.6)

Note: ^aStandard population from Eurostat.²⁷

Abbreviations: ASR, age-standardised incidence rates; CI, confidence interval; IR, incidence rate; PY, person-years.

Table S2 Distribution of patient characteristics and lifestyle factors in patients with tinnitus and their matched controls, stratified by sex

	Men (n=53,874)				Women (n=55,909)
	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)
Neurological/psychological disorders
Insomnia	5942 (11.0)	4175 (7.8)	1.51 (1.45–1.58)	1.49 (1.43–1.56)	9002 (16.1)	6868 (12.3)	1.42 (1.37–1.48)	1.42 (1.37–1.47)
Anxiety	8806 (16.4)	6880 (12.8)	1.35 (1.31–1.40)	1.35 (1.30–1.40)	14,066 (25.2)	10,959 (19.6)	1.41 (1.37–1.45)	1.41 (1.37–1.46)
Depression	8143 (15.1)	6390 (11.9)	1.34 (1.29–1.39)	1.33 (1.28–1.38)	14,278 (25.5)	11,973 (21.4)	1.28 (1.24–1.32)	1.30 (1.26–1.34)
Seizure/Epilepsy	1231 (2.3)	1267 (2.4)	0.97 (0.90–1.05)	0.98 (0.90–1.06)	1162 (2.1)	1099 (2.0)	1.06 (0.97–1.15)	1.06 (0.97–1.15)
Multiple Sclerosis	98 (0.2)	126 (0.2)	0.78 (0.60–1.01)	0.79 (0.60–1.03)	226 (0.4)	243 (0.4)	0.93 (0.78–1.12)	0.94 (0.78–1.12)
Schizophrenia	333 (0.6)	402 (0.8)	0.83 (0.71–0.96)	0.84 (0.72–0.98)	290 (0.5)	429 (0.8)	0.67 (0.58–0.78)	0.70 (0.60–0.81)
Parkinson Disease	124 (0.2)	228 (0.4)	0.54 (0.44–0.68)	0.54 (0.44–0.68)	132 (0.2)	183 (0.3)	0.72 (0.58–0.90)	0.74 (0.59–0.92)
Dementia	106 (0.2)	207 (0.4)	0.50 (0.40–0.64)	0.51 (0.41–0.65)	176 (0.3)	453 (0.8)	0.38 (0.32–0.45)	0.38 (0.32–0.46)
Cardiovascular disorders
Arrhythmia	3111 (5.8)	2632 (4.9)	1.21 (1.14–1.28)	1.16 (1.09–1.22)	3263 (5.8)	2672 (4.8)	1.25 (1.18–1.32)	1.22 (1.16–1.29)
Hypertension	12,176 (22.6)	11,907 (22.1)	1.04 (1.00–1.07)	0.98 (0.94–1.01)	13,812 (24.7)	13,702 (24.5)	1.01 (0.98–1.05)	0.98 (0.95–1.01)
Myocardial infarction	2120 (3.9)	2121 (3.9)	1.00 (0.94–1.07)	0.96 (0.90–1.02)	815 (1.5)	853 (1.5)	0.95 (0.86–1.05)	0.92 (0.84–1.02)
Congestive heart failure	766 (1.4)	828 (1.5)	0.92 (0.83–1.02)	0.89 (0.80–0.98)	739 (1.3)	765 (1.4)	0.96 (0.87–1.07)	0.95 (0.86–1.06)
Stroke/TIA	1703 (3.2)	1906 (3.5)	0.89 (0.83–0.95)	0.86 (0.81–0.93)	1682 (3.0)	1829 (3.3)	0.91 (0.85–0.98)	0.90 (0.84–0.97)
Metabolic disorders
Hyperlipidemia	6238 (11.6)	5445 (10.1)	1.19 (1.14–1.24)	1.13 (1.09–1.18)	5843 (10.5)	5150 (9.2)	1.18 (1.13–1.23)	1.16 (1.11–1.21)
Hypothyroidism	1074 (2.0)	899 (1.7)	1.20 (1.10–1.31)	1.16 (1.06–1.27)	5151 (9.2)	4601 (8.2)	1.14 (1.09–1.18)	1.12 (1.07–1.17)
Hyperthyroidism	312 (0.6)	285 (0.5)	1.10 (0.93–1.29)	1.04 (0.89–1.23)	1211 (2.2)	1078 (1.9)	1.13 (1.04–1.22)	1.13 (1.04–1.23)
Diabetes mellitus	3839 (7.1)	4280 (7.9)	0.88 (0.84–0.93)	0.83 (0.79–0.87)	3076 (5.5)	3346 (6.0)	0.91 (0.87–0.96)	0.88 (0.84–0.93)
Other disorders
Irritable bowel syndrome	3405 (6.3)	2028 (3.8)	1.74 (1.64–1.84)	1.66 (1.57–1.76)	7603 (13.6)	5260 (9.4)	1.53 (1.48–1.59)	1.51 (1.46–1.57)
Fibromyalgia	388 (0.7)	262 (0.5)	1.50 (1.28–1.76)	1.50 (1.27–1.76)	1200 (2.2)	791 (1.4)	1.55 (1.41–1.70)	1.54 (1.40–1.68)
Asthma	7577 (14.1)	6743 (12.5)	1.15 (1.11–1.19)	1.09 (1.05–1.13)	9053 (16.2)	8099 (14.5)	1.15 (1.11–1.18)	1.12 (1.09–1.16)
Rheumatoid Arthritis	475 (0.9)	413 (0.8)	1.15 (1.01–1.32)	1.13 (0.99–1.29)	1004 (1.8)	923 (1.7)	1.09 (1.00–1.19)	1.09 (0.99–1.19)
COPD	1535 (2.9)	1576 (2.9)	0.97 (0.90–1.05)	0.99 (0.91–1.06)	1313 (2.4)	1486 (2.7)	0.88 (0.81–0.95)	0.91 (0.84–0.98)

Notes: ^aAdjusted for BMI category, smoking status, alcohol consumption. Comorbidities listed according to their odds ratios in decreasing order

Abbreviations: CI, confidence interval; COPD, Chronic obstructive pulmonary disease; OR, odds ratio; TIA, transient ischemic attack.

Table S3 Distribution of comorbidities in patients with tinnitus and their matched controls, stratified by sex: otological and vestibular disorders

	Men (n=53,874)				Women (n=55,909)
	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)
Sensorineural Hearing Loss
≤30 days prior to (includigng) the ID	330 (0.6)	<5^b (0.0)	166.11 (41.47–665.34)	171.24 (42.74–686.06)	288 (0.5)	<5^b (0.0)	148.37 (36.97–595.42)	153.01 (38.12–614.15)
31 to 360 days prior to the ID	85 (0.2)	31 (0.1)	2.94 (1.93–4.49)	2.84 (1.86–4.35)	94 (0.2)	29 (0.1)	3.42 (2.24–5.21)	3.36 (2.20–5.13)
>360 days prior to the ID	565 (1.1)	380 (0.7)	1.52 (1.33–1.73)	1.52 (1.33–1.74)	577 (1.0)	321 (0.6)	1.88 (1.64–2.16)	1.88 (1.63–2.16)
Acute vestibular neuronitis
≤30 days prior to (includigng) the ID	18 (0.0)	<5^b (0.0)	17.98 (2.40–134.54)	17.90 (2.38–134.45)	19 (0.0)	0 (0.0)	NA	NA
31 to 360  days prior to the ID	23 (0.0)	5 (0.0)	4.60 (1.75–12.10)	3.95 (1.50–10.46)	45 (0.1)	22 (0.0)	2.10 (1.25–3.52)	1.98 (1.17–3.34)
>360 days prior to the ID	123 (0.2)	78 (0.1)	1.58 (1.19–2.09)	1.49 (1.12–1.99)	267 (0.5)	158 (0.3)	1.70 (1.39–2.07)	1.69 (1.39–2.07)
Otitis media
≤30 days prior to (includigng) the ID	548 (1.0)	13 (0.0)	44.05 (25.41–76.36)	43.55 (25.11–75.54)	566 (1.0)	38 (0.1)	15.74 (11.33–21.86)	15.76 (11.34–21.91)
31 to 360 days prior to the ID	784 (1.5)	201 (0.4)	4.12 (3.52–4.82)	4.09 (3.49–4.79)	969 (1.7)	288 (0.5)	3.62 (3.17–4.14)	3.62 (3.17–4.14)
>360 days prior to the ID	5171 (9.6)	4391 (8.2)	1.27 (1.21–1.33)	1.24 (1.19–1.30)	6381 (11.4)	5092 (9.1)	1.38 (1.32–1.44)	1.37 (1.32–1.43)
Labyrinthitis
≤30 days prior to (includigng) the ID	155 (0.3)	5 (0.0)	31.29 (12.84–76.23)	29.62 (12.14–72.28)	253 (0.5)	15 (0.0)	17.46 (10.37–29.40)	17.05 (10.11–28.73)
31 to 360 days prior to the ID	298 (0.6)	89 (0.2)	3.47 (2.73–4.40)	3.43 (2.69–4.36)	569 (1.0)	188 (0.3)	3.16 (2.68–3.74)	3.07 (2.60–3.64)
>360 days prior to the ID	1453 (2.7)	992 (1.8)	1.51 (1.39–1.64)	1.47 (1.35–1.59)	2885 (5.2)	2022 (3.6)	1.49 (1.40–1.58)	1.46 (1.38–1.55)
Conductive Hearing Loss
≤30 days prior to (includigng) the ID	19 (0.0)	<5^b (0.0)	18.97 (2.54–141.51)	21.20 (2.81–159.97)	33 (0.1)	<5^b (0.0)	16.49 (3.96–68.68)	18.60 (4.45–77.82)
31 to 360 days prior to the ID	13 (0.0)	<5^b (0.0)	6.50 (1.47–28.80)	6.95 (1.55–31.13)	16 (0.0)	<5^b (0.0)	8.00 (1.84–34.79)	7.62 (1.75–33.25)
>360 days prior to the ID	127 (0.2)	112 (0.2)	1.13 (0.88–1.46)	1.10 (0.85–1.43)	163 (0.3)	117 (0.2)	1.40 (1.10–1.77)	1.39 (1.09–1.76)
Benign positional vertigo
≤30 days prior to (includigng) the ID	146 (0.3)	12 (0.0)	12.61 (6.99–22.74)	11.95 (6.61–21.60)	316 (0.6)	25 (0.0)	13.32 (8.86–20.03)	13.33 (8.86–20.06)
31 to 360 days prior to the ID	344 (0.6)	124 (0.2)	2.92 (2.37–3.60)	2.80 (2.27–3.46)	616 (1.1)	274 (0.5)	2.39 (2.07–2.77)	2.33 (2.01–2.69)
>360 days prior to the ID	1189 (2.2)	725 (1.4)	1.70 (1.55–1.87)	1.65 (1.50–1.82)	2299 (4.1)	1569 (2.8)	1.54 (1.44–1.65)	1.52 (1.42–1.63)
Cerumen
≤30 days prior to (includigng) the ID	2502 (4.6)	237 (0.4)	11.83 (10.32–13.56)	11.58 (10.10–13.29)	1747 (3.1)	170 (0.3)	11.57 (9.84–13.61)	11.50 (9.77–13.53)
31 to 360 days prior to the ID	3737 (6.9)	2037 (3.8)	2.11 (1.99–2.24)	2.06 (1.94–2.18)	2943 (5.3)	1475 (2.6)	2.23 (2.09–2.38)	2.19 (2.05–2.34)
>360 days prior to the ID	7841 (14.6)	8009 (14.9)	1.10 (1.06–1.14)	1.07 (1.04–1.11)	6861 (12.3)	6504 (11.6)	1.16 (1.12–1.21)	1.15 (1.11–1.20)
Otitis externa
≤30 days prior to (includigng) the ID	970 (1.8)	96 (0.2)	10.81 (8.74–13.36)	10.71 (8.65–13.25)	905 (1.6)	107 (0.2)	9.03 (7.38–11.06)	9.10 (7.43–11.15)
31 to 360 days prior to the ID	1713 (3.2)	717 (1.3)	2.56 (2.34–2.80)	2.56 (2.34–2.80)	1862 (3.3)	789 (1.4)	2.54 (2.33–2.76)	2.53 (2.32–2.75)
>360 days prior to the ID	6353 (11.8)	5585 (10.4)	1.22 (1.17–1.27)	1.20 (1.15–1.25)	6818 (12.2)	5500 (9.8)	1.34 (1.29–1.39)	1.33 (1.28–1.38)

Notes: ^aAdjusted for BMI category, smoking status, alcohol consumption. ^bFor confidentiality reasons, we do not provide the number of patients in categories containing less than five patients.

Abbreviations: CI, confidence interval; ID, index date; NA, not available; OR, odds ratio.

Table S4 Distribution of comorbidities in patients with tinnitus and their matched controls, stratified by sex: head and neck disorders

	Men (n=53,874)				Women (n=55,909)
	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)	Tinnitus cases (%)	Tinnitus-free controls (%)	OR crude (95% CI)	OR adjusted^a (95% CI)
Tension-type headache
≤30 days prior to (includigng) the ID	38 (0.1)	0 (0.0)	NA	NA	66 (0.1)	9 (0.0)	7.47 (3.72–14.99)	7.55 (3.76–15.18)
31 to 360 days prior to the ID	117 (0.2)	48 (0.1)	2.47 (1.77–3.46)	2.38 (1.70–3.35)	242 (0.4)	97 (0.2)	2.56 (2.02–3.24)	2.57 (2.03–3.26)
>360 days prior to the ID	1143 (2.1)	708 (1.3)	1.64 (1.49–1.81)	1.57 (1.43–1.73)	2188 (3.9)	1468 (2.6)	1.54 (1.44–1.65)	1.52 (1.42–1.63)
Concussion
≤30 days prior to (includigng) the ID	14 (0.0)	<5^b (0.0)	14.00 (1.84–106.41)	13.36 (1.74–102.45)	11 (0.0)	<5^b (0.0)	5.50 (1.22–24.80)	5.98 (1.32–27.08)
31 to 360 days prior to the ID	15 (0.0)	7 (0.0)	2.14 (0.87–5.26)	2.31 (0.93–5.75)	24 (0.0)	12 (0.0)	2.00 (1.00–4.00)	2.00 (1.00–4.01)
>360 days prior to the ID	332 (0.6)	324 (0.6)	1.03 (0.88–1.20)	1.02 (0.88–1.20)	207 (0.4)	173 (0.3)	1.20 (0.98–1.47)	1.21 (0.99–1.49)
Temporomandibular joint disorders
≤30 days prior to (includigng) the ID	38 (0.1)	7 (0.0)	5.43 (2.42–12.15)	5.27 (2.34–11.85)	77 (0.1)	10 (0.0)	7.81 (4.05–15.10)	7.59 (3.92–14.70)
31 to 360 days prior to the ID	106 (0.2)	38 (0.1)	2.80 (1.93–4.06)	2.73 (1.88–3.97)	202 (0.4)	106 (0.2)	1.93 (1.53–2.45)	1.86 (1.47–2.36)
>360 days prior to the ID	696 (1.3)	413 (0.8)	1.70 (1.51–1.93)	1.64 (1.44–1.85)	1627 (2.9)	1088 (2.0)	1.53 (1.41–1.65)	1.50 (1.39–1.62)
Whiplash
≤30 days prior to (includigng) the ID	44 (0.1)	7 (0.0)	6.44 (2.90–14.30)	5.77 (2.59–12.86)	42 (0.1)	8 (0.0)	5.27 (2.47–11.22)	5.12 (2.40–10.92)
31 to 360 days prior to the ID	160 (0.3)	112 (0.2)	1.45 (1.13–1.84)	1.41 (1.10–1.81)	185 (0.3)	120 (0.2)	1.56 (1.24–1.97)	1.54 (1.22–1.94)
>360 days prior to the ID	2144 (4.0)	1724 (3.2)	1.26 (1.18–1.35)	1.25 (1.17–1.33)	2373 (4.2)	2054 (3.7)	1.17 (1.10–1.25)	1.16 (1.09–1.23)
Cervicalgia
≤30 days prior to (includigng) the ID	425 (0.8)	81 (0.2)	5.57 (4.39–7.07)	5.41 (4.26–6.88)	560 (1.0)	129 (0.2)	4.90 (4.03–5.95)	4.80 (3.94–5.83)
31 to 360 days prior to the ID	1184 (2.2)	674 (1.3)	1.90 (1.72–2.09)	1.81 (1.64–2.00)	1816 (3.3)	1066 (1.9)	1.88 (1.74–2.03)	1.83 (1.69–1.98)
>360 days prior to the ID	7533 (14.0)	5411 (10.0)	1.53 (1.47–1.59)	1.49 (1.43–1.55)	10,542 (18.9)	7988 (14.3)	1.48 (1.43–1.53)	1.46 (1.41–1.51)
Migraine
≤30 days prior to (includigng) the ID	103 (0.2)	17 (0.0)	6.16 (3.69–10.30)	5.73 (3.42–9.60)	243 (0.4)	63 (0.1)	4.09 (3.10–5.39)	3.98 (3.01–5.26)
31 to 360 days prior to the ID	246 (0.5)	134 (0.3)	1.87 (1.51–2.31)	1.77 (1.43–2.19)	799 (1.4)	469 (0.8)	1.81 (1.62–2.04)	1.76 (1.57–1.98)
>360 days prior to the ID	2821 (5.2)	1988 (3.7)	1.45 (1.37–1.54)	1.41 (1.33–1.49)	6698 (12.0)	5172 (9.3)	1.37 (1.32–1.42)	1.35 (1.30–1.40)
Cranial nerve disorders
≤30 days prior to (includigng) the ID	33 (0.1)	10 (0.0)	3.30 (1.63–6.70)	3.43 (1.68–6.99)	57 (0.1)	11 (0.0)	5.23 (2.74–9.98)	5.14 (2.69–9.83)
31 to 360 days prior to the ID	122 (0.2)	53 (0.1)	2.36 (1.70– 3.28)	2.26 (1.62–3.14)	220 (0.4)	124 (0.2)	1.78 (1.43–2.23)	1.75 (1.40–2.19)
>360 days prior to the ID	874 (1.6)	722 (1.3)	1.22 (1.10– 1.35)	1.21 (1.09–1.33)	1412 (2.5)	1050 (1.9)	1.36 (1.26–1.48)	1.37 (1.26–1.48)

Notes: ^aAdjusted for BMI category, smoking status, alcohol consumption. ^bFor confidentiality reasons, we do not provide the number of patients in categories containing less than five patients.

Abbreviations: CI, confidence interval; ID, index date; NA, not available; OR, odds ratio.

Eurostat. Revision of the European Standard Population: Report of Eurostat’s Task Force. Luxembourg: Publications Office of the European Union. 2013.

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