Bidirectional Associations Between Tinnitus Subtypes and Psychiatric Conditions

ABSTRACT Objective To evaluate the temporal and bidirectional relationships between tinnitus subtypes—pulsatile tinnitus (PT) and non‐pulsatile tinnitus (NPT)—and psychiatric conditions, specifically generalized anxiety disorder (GAD) and major depression (MD). Methods This retrospective cohort study utilized data from the TriNetX Research Network, including over 140 million patients. Patients were categorized based on ICD‐10 codes for PT, NPT, GAD, and MD. Propensity score matching (PSM) was applied to control for demographic and clinical confounders. Statistical analyses included chi‐square tests, odds ratios (OR) with 95% confidence intervals (CIs) to ascertain the statistical significance of temporal associations between tinnitus subtypes and psychiatric conditions. Results NPT patients had significantly higher risks of developing GAD and MD than PT patients. PSM analyses confirmed that PT patients had consistently lower risks of developing these conditions, even across treated and untreated subgroups. Among patients with tinnitus, those with PT had significantly higher rates of pre‐existing GAD and MD compared to those with NPT. Conclusion NPT is associated with significantly higher risks of developing GAD and MD compared to PT, highlighting a greater psychiatric burden among this subgroup. Conversely, patients with tinnitus who had pre‐existing GAD or MD were more likely to have PT than NPT, suggesting a bidirectional relationship. These findings underscore the importance of integrating mental health assessment into tinnitus care and inform future research into subtype‐specific management strategies. Level of Evidence 3