Tinnitus prevalence and characteristics in the United States: insights from a cross-sectional analysis of the 2019–2022 Apple Hearing Study cohort

Abstract Background Tinnitus is a complex condition with significant heterogeneity in its presentation, and its risk factors remain poorly characterized, posing challenges for prevention, diagnosis, and treatment. This study aimed to assess the prevalence, characteristics, and risk factors of tinnitus in the United States (U.S.) using large-scale survey data. Methods We conducted a cross-sectional analysis of 125,252 volunteer adults (≥ 18 years) enrolled in the Apple Hearing Study, a nationwide app-based cohort of iPhone users in the U.S. (November 2019–November 2022). The outcomes were the weighted prevalence of any tinnitus and bothersome tinnitus, measured using self-reported tinnitus frequency, duration, awareness, loudness, and interference with hearing. Age-adjusted and multivariable logistic regression models were applied to analyze the odds ratios of self-reported potential risk factors on tinnitus, and a weighted decision tree identified the strongest predictors of bothersome tinnitus. Results The estimated weighted national prevalence of any tinnitus was 30.8% (95% Confidence Interval [CI]: [30.3%, 31.2%]) and bothersome tinnitus was 11.6% (95% CI: [11.3%, 11.9%]). Controlling for age, sex, race/ethnicity, and other sociodemographic characteristics, self-rated hearing ability was the strongest risk factor for any tinnitus (odds ratios of 4.52 [95% CI: 4.03–5.06] and bothersome tinnitus 8.88 [95% CI: 7.52–10.49], comparing poor to excellent hearing). The odds of both types of tinnitus increased with age, peaking in the 60–64 age group (2.01 [95% CI: 1.77–2.28] for any tinnitus and 2.72 [95% CI: 2.24–3.92] for bothersome tinnitus) after adjusting for the same set of variables. Non-Hispanic Whites had higher odds of any and bothersome tinnitus compared to other race/ethnicities. A reported history of occupational noise exposure was associated with higher odds of any and bothersome tinnitus. Conclusions Approximately 3 in 10 U.S. adults are estimated to experience any tinnitus, and about 1 in 10 affected by bothersome tinnitus. Tinnitus is associated with worse self-rated hearing ability, age, race/ethnicity, and a history of workplace noise. These results align with prior epidemiological estimates and demonstrate the feasibility of using app-based platforms to collect large-scale, high-quality hearing health data.