Anxiety and depression symptoms in patients with tinnitus: systematic review




Tinnitus; Depression; Anxiety.


Objective: to compare tinnitus sufferers to non-sufferers, regarding the presence of symptoms of anxiety and depression. Methodology: PubMed and Lilacs databases were searched for cross-sectional, cohort or case-control studies, with adult humans. The studies have been selected through a two-step process (title/abstract screening and full text reading). The study selection, data extraction and assessment of study quality were made independently by two reviewers. Results: 29 studies were included, totalizing 1,208,435 participants. 78% and 76% of the studies found a significant (p < 0,05) positive association between tinnitus and depression and anxiety, respectively. All the studies that compared the non-annoying tinnitus subgroup to controls found a significant (p < 0,05) positive association between non-annoying tinnitus and depression. All the studies that assessed the correlation between tinnitus-related annoyance and anxiety or depression levels found a significant (p < 0,05) positive correlation. Conclusion: tinnitus sufferers have greater odds of anxiety and depression symptoms than non-sufferers, and such finding is independent of hearing loss. The more annoying the tinnitus, the greater the prevalence and severity of the negative emotional symptoms; however, even not annoying tinnitus is associated with greater odds of depression.


Aazh, H., & Moore, B. C. (2017). Factors associated with depression in patients with tinnitus and hyperacusis. American Journal of Audiology, 26(4), 562–569.

Andersson, G., Eriksson, J., Lundh, L.-G., & Lyttkens, L. (2000). Tinnitus and cognitive interference. Journal of Speech, Language, and Hearing Research, 43(5), 1168–1173.

Baguley, D., McFerran, D., & Hall, D. (2013). Tinnitus. The Lancet, 382(9904), 1600–1607.

Ban, M. J., Kim, W. S., Park, K. N., Kim, J. W., Lee, S. W., Han, K., Chang, J. W., Byeon, H. K., Koh, Y. W., & Park, J. H. (2018). Korean survey data reveals an association of chronic laryngitis with tinnitus in men. PLOS ONE, 13(1).

Blaesing, L., & Kroener-Herwig, B. (2012). Self-reported and behavioral sound avoidance in tinnitus and hyperacusis subjects, and association with Anxiety Ratings. International Journal of Audiology, 51(8), 611–617.

Bonett, D. G., & Price, R. M. (2020). Confidence intervals for ratios of means and medians. Journal of Educational and Behavioral Statistics, 45(6), 750–770.

Brännström, K. J., & Waechter, S. (2018). Reading comprehension in quiet and in noise: Effects on immediate and delayed recall in relation to tinnitus and high-frequency hearing thresholds. Journal of the American Academy of Audiology, 29(06), 503–511.

Granjeiro, R. C., Kehrle, H. M., Oliveira, T. S. C., Sampaio, A. L. L., & Oliveira, C. A. C. P. (2013). Is the degree of discomfort caused by tinnitus in normal-hearing individuals correlated with psychiatric disorders? Otolaryngology–Head and Neck Surgery, 148(4), 658–663.

Danioth, L., Brotschi, G., Croy, I., Friedrich, H., Caversaccio, M.-D., & Negoias, S. (2020). Multisensory environmental sensitivity in patients with chronic tinnitus. Journal of Psychosomatic Research, 135, 110155.

Durai, M., & Searchfield, G. (2016). Anxiety and depression, personality traits relevant to tinnitus: A scoping review. International Journal of Audiology, 55(11), 605–615.

Fuller, T., Cima, R., Langguth, B., Mazurek, B., Vlaeyen, J. W. S., & Hoare, D. J. (2020). Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews, 2020(1).

Galvão, T. F., & Pereira, M. G. (2014). Revisões Sistemáticas da Literatura: Passos para sua elaboração. Epidemiologia e Serviços De Saúde, 23(1), 183–184.

Genç, G. A., Muluk, N. B., & Belgin, E. (2013). The effects of tinnitus and/or hearing loss on the symptom checklist-90-revised test. Auris Nasus Larynx, 40(2), 154–161.

Geocze, L., Mucci, S., Abranches, D. C., Marco, M. A., & Penido, N. de. (2013). Systematic review on the evidences of an association between tinnitus and Depression. Brazilian Journal of Otorhinolaryngology, 79(1), 106–111.

Gibrin, P. C., Ciquinato, D. S., Gonçalves, I. C., Marchiori, V. de, & Marchiori, L. L. (2019). Tinnitus and its relationship with anxiety and depression in the elderly: A systematic review. Revista CEFAC, 21(4).

Gomaa, M. A., Elmagd, M. H., Elbadry, M. M., & Kader, R. M. (2013). Depression, anxiety and stress scale in patients with tinnitus and hearing loss. European Archives of Oto-Rhino-Laryngology, 271(8), 2177–2184.

Gopinath, B., McMahon, C. M., Rochtchina, E., Karpa, M. J., & Mitchell, P. (2010). Risk factors and impacts of incident tinnitus in older adults. Annals of Epidemiology, 20(2), 129–135.

Granjeiro C. R. (2011). Relação do Incômodo do Zumbido com a Função das Células Ciliadas Externas e os Transtornos de Ansiedade e Depressão em Indivíduos com Limiar Auditivo Normal. [Tese de doutorado, Universidade de Brasília]. Biblioteca Digital Brasileira de Teses e Dissertações.

Gu, J. W., Halpin, C. F., Nam, E.-C., Levine, R. A., & Melcher, J. R. (2010). Tinnitus, diminished sound-level tolerance, and elevated auditory activity in humans with clinically normal hearing sensitivity. Journal of Neurophysiology, 104(6), 3361–3370.

Halford, J. B. S., & Anderson, S. D. (1991). Anxiety and depression in tinnitus sufferers. Journal of Psychosomatic Research, 35(4-5), 383–390.

Han, K.-M., Ko, Y.-H., Shin, C., Lee, J.-H., Choi, J., Kwon, D.-Y., Yoon, H.-K., Han, C., & Kim, Y.-K. (2018). Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample. Journal of Psychiatric Research, 98, 124–132.

Honório, H. M., & Santiago, J. F., Jr. (2021a) Planejamento das revisões sistemáticas. In Honório, H. M., & Santiago, J. F., Jr. (Eds.) Fundamentos das revisões sistemáticas em saúde. (pp. 35-64) Santos Publicações.

Honório, H. M., & Santiago, J. F., Jr. (2021b) Revisões sistemáticas: definição, importância e limitações. In Honório, H. M., & Santiago, J. F., Jr. (Eds.) Fundamentos das revisões sistemáticas em saúde. (pp. 3-22) Santos Publicações.

House, L., Bishop, C. E., Spankovich, C., Su, D., Valle, K., & Schweinfurth, J. (2017). Tinnitus and its risk factors in African Americans: The Jackson Heart Study. The Laryngoscope, 128(7), 1668–1675.

Jackson, J. G., Coyne, I. J., & Clough, P. J. (2013). A preliminary investigation of potential cognitive performance decrements in non-help-seeking tinnitus sufferers. International Journal of Audiology, 53(2), 88–93.

Joo, Y.-H., Han, K.-do, & Park, K. H. (2015). Association of Hearing Loss and tinnitus with health-related quality of life: The Korea National Health and Nutrition Examination Survey. PLOS ONE, 10(6).

Kao, L.-T., Shih, J.-H., Yeh, C.-B., Wang, C.-H., Chen, H.-C., Chien, W. C., & Li, I.-H. (2020). Association between major depressive disorder and subsequent tinnitus: A population-based study. Journal of Affective Disorders, 263, 367–372.

Krog, N. H., Engdahl, B., & Tambs, K. (2010). The association between tinnitus and mental health in a general population sample: Results from the hunt study. Journal of Psychosomatic Research, 69(3), 289–298.

Langguth, B. (2011). A review of tinnitus symptoms beyond ‘ringing in the ears’: A call to action. Current Medical Research and Opinion, 27(8), 1635–1643.

Langguth, B., Landgrebe, M., Kleinjung, T., Sand, G. P., & Hajak, G. (2011). Tinnitus and depression. The World Journal of Biological Psychiatry, 12(7), 489–500.

Lin, C.-E., Chen, L.-F., Chou, P.-H., & Chung, C.-H. (2018). Increased prevalence and risk of anxiety disorders in adults with tinnitus: A population-based study in Taiwan. General Hospital Psychiatry, 50, 131–136.

Loprinzi, P. D., Maskalick, S., Brown, K., & Gilham, B. (2013). Association between depression and tinnitus in a nationally representative sample of US older adults. Aging & Mental Health, 17(6), 714–717.

Malakouti S., Mahmoudian M., Alifattahi N., & Salehi M. (2011). Comorbidity of chronic tinnitus and mental disorders. International Tinnitus Journal, 16(2):118-122.

Mamani. M. P., Honório, H. M., & Santiago J. F., Jr. (2021) Seleção e extração de dados. In Honório, H. M., & Santiago, J. F., Jr. (Eds.) Fundamentos das revisões sistemáticas em saúde. (pp. 191-212) Santos Publicações.

McCormack, A., Edmondson-Jones, M., Fortnum, H., Dawes, P. D., Middleton, H., Munro, K. J., & Moore, D. R. (2015). Investigating the association between tinnitus severity and symptoms of depression and anxiety, while controlling for neuroticism, in a large middle-aged UK population. International Journal of Audiology, 54(9), 599–604.

McKenzie J. E., & Brennan S. E. (2021). Chapter 12: Synthesizing and presenting findings using other methods. In Higgins J. P. T., Thomas J., Chandler J., Cumpston M., Li T., Page M. J., & Welch V. A. (Eds.) Cochrane Handbook for Systematic Reviews of Interventions. Cochrane.

Michikawa, T., Nishiwaki, Y., Saito, H., Mizutari, K., & Takebayashi, T. (2013). Tinnitus preceded depressive symptoms in community-dwelling older Japanese: A prospective cohort study. Preventive Medicine, 56(5), 333–336.

Moola S., Munn Z., Tufanaru C., Aromataris E., Sears K., Sfetcu R., Currie M., Qureshi R., Mattis P., Lisy K., & Mu P.-F. (2020) Checklist for Analytical Cross Sectional Studies.

Nondahl, D. M., Cruickshanks, K. J., Dalton, D. S., Klein, B. E. K., Klein, R., Schubert, C. R., Tweed, T. S., & Wiley, T. L. (2007). The impact of tinnitus on quality of life in older adults. Journal of the American Academy of Audiology, 18(03), 257–266.

Oosterloo, B. C., de Feijter, M., Croll, P. H., Baatenburg de Jong, R. J., Luik, A. I., & Goedegebure, A. (2021). Cross-sectional and longitudinal associations between tinnitus and mental health in a population-based sample of middle-aged and elderly persons. JAMA Otolaryngology–Head & Neck Surgery, 147(8), 708.

Pajor, A. M., Ormezowska, E. A., & Jozefowicz-Korczynska, M. (2012). The impact of co-morbid factors on the psychological outcome of tinnitus patients. European Archives of Oto-Rhino-Laryngology, 270(3), 881–888.

Park, E., Kim, H., Choi, I. H., Han, H. M., Han, K., Jung, H. H., & Im, G. J. (2020). Psychiatric distress as a common risk factor for tinnitus and joint pain: A national population-based survey. Clinical and Experimental Otorhinolaryngology, 13(3), 234–240.

Park, H.-M., Jung, J., Kim, J.-K., & Lee, Y.-J. (2020). Tinnitus and its association with mental health and health-related quality of life in an older population: A nationwide cross-sectional study. Journal of Applied Gerontology, 41(1), 181–186.

Park, S. Y., Han, J. J., Hwang, J. H., Whang, E. S., Yeo, S. W., & Park, S. N. (2017). Comparison of tinnitus and psychological aspects between the younger and older adult patients with tinnitus. Auris Nasus Larynx, 44(2), 147–151.

Pattyn, T., Van Den Eede, F., Vanneste, S., Cassiers, L., Veltman, D. J., Van De Heyning, P., & Sabbe, B. C. G. (2016). Tinnitus and anxiety disorders: A Review. Hearing Research, 333, 255–265.

Pinto, P. C., Marcelos, C. M., Mezzasalma, M. A., Osterne, F. J., de Melo Tavares de Lima, M. A., & Nardi, A. E. (2014). Tinnitus and its association with Psychiatric Disorders: Systematic Review. The Journal of Laryngology & Otology, 128(8), 660–664.

Reis, A., Favoreto, M. W., Lauris, J. R. P., & Loguercio, A. D. (2021) Análise de dados em revisões sistemáticas. In Honório, H. M., & Santiago, J. F., Jr. (Eds.) Fundamentos das revisões sistemáticas em saúde. (pp. 214-246) Santos Publicações.

Rivera, M., Porras-Segovia, A., Rovira, P., Molina, E., Gutiérrez, B., & Cervilla, J. (2019). Associations of major depressive disorder with chronic physical conditions, obesity and medication use: Results from the Pisma-EP study. European Psychiatry, 60, 20–27.

Salazar, J. W., Meisel, K., Smith, E. R., Quiggle, A., McCoy, D. B., & Amans, M. R. (2019). Depression in patients with tinnitus: A systematic review. Otolaryngology–Head and Neck Surgery, 161(1), 28–35.

Salonen, J., Johansson, R., & Joukamaa, M. (2007). Alexithymia, depression and tinnitus in elderly people. General Hospital Psychiatry, 29(5), 431–435.

Seo, J. H., Kang, J. M., Hwang, S. H., Han, K. D., & Joo, Y. H. (2016). Relationship between tinnitus and suicidal behaviour in Korean men and women: A cross-sectional study. Clinical Otolaryngology, 41(3), 222–227.

Seydell-Greenwald, A., Leaver, A. M., Turesky, T. K., Morgan, S., Kim, H. J., & Rauschecker, J. P. (2012). Functional MRI evidence for a role of ventral prefrontal cortex in tinnitus. Brain Research, 1485, 22–39.

Snaith, R. P., & Zigmond, A. S. (1986). The hospital anxiety and depression scale. BMJ, 292(6516), 344–344.

Stevens, C., Walker, G., Boyer, M., & Gallagher, M. (2007). Severe tinnitus and its effect on selective and divided attention. International Journal of Audiology, 46(5), 208–216.

Trevis, K. J., McLachlan, N. M., & Wilson, S. J. (2016). Cognitive mechanisms in chronic tinnitus: Psychological markers of a failure to switch attention. Frontiers in Psychology, 7.

Trevis, K. J., McLachlan, N. M., & Wilson, S. J. (2018). A systematic review and meta-analysis of psychological functioning in chronic tinnitus. Clinical Psychology Review, 60, 62–86.

Waechter, S. (2021). Association between hearing status and tinnitus distress. Acta Oto-Laryngologica, 141(4), 381–385.

Waechter, S., & Brännström, K. J. (2015). The impact of tinnitus on cognitive performance in normal-hearing individuals. International Journal of Audiology, 54(11), 845–851.

Waechter, S., Hallendorf, L., Malmstein, E., Olsson, A., & Brannstrom, K. J. (2018). The impact of tinnitus on N-back performance in normal hearing individuals. Journal of the American Academy of Audiology.

Wells, G. A., Shea, B., O'Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (s.d.) Newcastle-Ottawa Quality Assessment Scale.

Worrall, D. M., & Cosetti, M. K. (2021) Tinnitus and Hyperacusis. In Flint P. W., Francis H. W., Haughey B. H., Lesperance M. M., Lund V. J., Robbins K. T., & Thomas, J. R. (Eds.) Cummings Otolaryngology – Head and Neck Surgery. (pp. 2328-2341) Elsevier.

Xu, Y., Yao, J., Zhang, Z., & Wang, W. (2016). Association between sleep quality and psychiatric disorders in patients with subjective tinnitus in China. European Archives of Oto-Rhino-Laryngology, 273(10), 3063–3072.

Yu, J.-N., Nam, G. E., Han, K., Kim, J.-su, Kim, Y.-H., Cho, K. H., Kang, G., & Roh, Y. K. (2019). Association between menstrual cycle irregularity and tinnitus: A nationwide population-based study. Scientific Reports, 9(1).

Ziai, K., Moshtaghi, O., Mahboubi, H., & Djalilian, H. R. (2017). Tinnitus patients suffering from anxiety and depression: A Review. The International Tinnitus Journal, 21(1).



How to Cite

PESARICO, J. P.; KOKUBO, L. C. P.; AZEREDO, L. M.; SILVA, P. B. da; GROTO, A. D. Anxiety and depression symptoms in patients with tinnitus: systematic review. Research, Society and Development, [S. l.], v. 11, n. 10, p. e533111033168, 2022. DOI: 10.33448/rsd-v11i10.33168. Disponível em: Acesso em: 4 oct. 2022.



Review Article