Tinnitus and Risk of Mortality in Normal-Hearing U.S. Adults: A Weighted Study Adjusted for Covariate Balance

Background: Tinnitus and hearing loss are both prevalent chronic conditions that can significantly impair quality of life. While prior studies have explored the association between tinnitus and mortality, many have failed to isolate the effect of tinnitus from that of coexisting hearing loss—a frequent comorbidity—which may have introduced confounding and biased the results. To investigate the association between tinnitus and both all-cause and cause-specific mortality among U.S. adults aged 20-69 years with normal hearing. Methods: We conducted a population-based cross-sectional analysis using data from five cycles of the National Health and Nutrition Examination Survey. Adults aged 20-69 years with audiometrically confirmed normal hearing were included. Tinnitus status was self-reported. Key covariates included demographic characteristics, comorbid conditions etc. We implemented propensity score matching and multivariable-adjusted Cox proportional hazards models to estimate the hazard ratios (HRs) for all-cause and cause-specific mortality. Results: Tinnitus was found to be significantly associated with an increased risk of all-cause mortality (HR: 1.84; 95% CI: 1.38-2.44). A particularly elevated risk was observed for cancer-specific mortality (HR: 2.11; 95% CI: 1.26-3.58). Importantly, these findings persisted after adjusting for multiple covariates in the matched cohort, highlighting the robustness of the results derived from a balanced comparison. Conclusions: Among U.S. adults with normal hearing, tinnitus was independently associated with increased risks of all-cause and cancer-specific mortality. These findings underscore the importance of recognizing tinnitus as not merely a benign symptom, but a potential marker of broader health risks, even in individuals without hearing impairment.