Tinnitus severity and dizziness: The role of psychological distress in a population-based study

OBJECTIVE: To investigate the association between tinnitus severity and dizziness in a nationally representative sample of adults aged ≥40 years and to evaluate the contribution of psychological distress (anxiety and perceived stress). METHODS: We analyzed data from 7634 participants in the Korea National Health and Nutrition Examination Survey (2022-2023). Dizziness was defined as self-reported symptoms within the past 12 months. Tinnitus severity was categorized as mild, moderate, or severe compared with no tinnitus. Survey-weighted logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) with sequential adjustment for sociodemographic factors, health behaviors, comorbidities, and psychological variables. RESULTS: Among adults aged 40 years and older, the weighted proportions of participants reporting dizziness and tinnitus symptoms were 33.7% and 10.2%, respectively. Tinnitus severity showed a graded association with dizziness (p for trend = 0.003 in Model 4). Compared with the no‑tinnitus group, moderate and severe tinnitus were associated with higher odds of dizziness after full adjustment (OR 1.71, 95% CI 1.33-2.20; OR 2.43, 95% CI 1.75-3.39). Anxiety severity and perceived stress were independently associated with dizziness, and adjustment for these factors attenuated the tinnitus-dizziness association by approximately 9% and 19% for moderate and severe tinnitus. CONCLUSIONS: Tinnitus severity was independently associated with dizziness in a graded manner. Psychological distress was also associated with dizziness and partially attenuated this relationship, supporting a clinical approach that integrates auditory and psychological factors in the assessment of dizziness.