The association between tinnitus and posttraumatic stress disorder.

PURPOSE Posttraumatic stress disorder (PTSD) affects nearly 10% of the population, a prevalence comparable with that of tinnitus. Similarities between the way PTSD and tinnitus influence auditory behaviors include exaggerated startle responses and decreased loudness tolerance. Tinnitus loudness is often exacerbated by sounds that trigger PTSD-related anxiety. This report addresses physical and psychological relations between PTSD and tinnitus. METHOD A chart review of veterans seen over a 4-year period for tinnitus services was conducted. Case history and self-assessments of tinnitus handicap were examined in all patients. A review of the literature related to triggers and effects of PTSD was conducted to explore potential consequences related to the presence of PTSD in the Veterans Affairs Medical Center (VAMC) tinnitus population. RESULTS Chart review confirmed that 34% of the first 300 patients enrolled in the VAMC Tinnitus Clinic also carried a diagnosis of PTSD. Patient reports citing tinnitus severity, suddenness of tinnitus onset, sound-tolerance problems, and sound-triggered exacerbation of tinnitus were more common for patients with a PTSD diagnosis than patients with tinnitus only. CONCLUSIONS Several neural mechanisms linked to both tinnitus and PTSD affect auditory behaviors. Audiologists should be aware that patients with tinnitus and PTSD will require test protocols and referrals that address these powerful responses.