Tinnitus is a head noise, which does not have an
external source. It is usually perceived by the patient alone and cannot be
heard by anyone outside. The noise may lasts for five or more minutes and may
occur at least once a week.
is largely considered a nonspecific symptom of an unknown dysfunction of the
hearing system and is associated with hearing loss of various degrees.
factors are associated with tinnitus ranging from genetic to iatrogenic, neurological to vascular.
However a proper explanation is still not available.
Any clinical condition
that causes a reduction in blood flow to the ear level can cause tinnitus or
trigger a flare in those patients already affected by this disorder.
Various clinical conditions are associated with
tinnitus and they include middle ear diseases, vascular diseases, hypertension,
diabetes, autoimmune disorders,
and degenerative neural disorders.
heart failure (CHF)
CHF could be considered as an ideal biological model
to test the vascular disregulatory hypothesis of tinnitus since it is linked to
reduced cardiac output.
Like tinnitus, CHF too is more prevalent in the
Method Of Study
A cross-sectional study was carried out on 958 consecutive elderly patients (age
>65 years) with a diagnosis of CHF
to correlate the relationship between tinnitus and the clinical prognosis of
mild-to-moderate chronic heart failure (CHF) in a large group of elderly
Blood pressure, echocardiographic parameters, brain natriuretic peptide
(BNP), hospitalization, and mortality for CHF were some of the parameters that
Multivariate logistic regression was used for analysis.
Patients who were excluded from the study include those with -
• Stage 3 to stage 5 chronic renal failure
• Recent increase in diuretic dosage (less than 30
• Diuretic dosage change during follow-up
• Use of other ototoxic drugs such as
• Continuous use of fully dosed non-steroidal
anti-inflammatory drugs (NSAIDs).
Each patient was
actively followed-up for a cumulative period of 12 months after enrolment in
To date, this is the first large, cross-sectional,
clinical study that has been carried out to link tinnitus and CHF in elderly
The study suggests that in the elderly, presence of
tinnitus is linked to a decline in LV function and that this could be the
result of insufficient auto regulatory mechanism related to circulation of the
The one-year hospitalization and mortality from CHF
was significantly increased in patients with tinnitus.
This may be considered as an indirect symptom
of poor hemodynamic stability in elderly CHF patients and allows for the early
identification of patients with CHF who need more aggressive management to
improve their quality of life.
The data from this study indirectly supports the hypothesis that tinnitus
is linked to poor CHF control in elderly patients and can have some important
clinical implications in the early identification of CHF patients who need
Tinnitus in elderly patients
and prognosis of mild-to-moderate congestive heart failure: a cross-sectional
study with a long-term extension of the clinical follow-up; Claudio Borghi et
al; BMC Medicine 2011.