Abstract
BackgroundTinnitus due to hyperactivity across neuronal ensembles along the auditory pathway is reported. We hypothesized that trigeminal neuralgia patients may subsequently suffer from tinnitus. Using nationwide, population-based data and a retrospective cohort study design, we investigated the risk of tinnitus within 1 year following trigeminal neuralgia.MethodsWe used the Taiwan National Health Insurance Research Dataset, a claims database, to identify all patients diagnosed with trigeminal neuralgia from January 2001 to December 2014, 12,587 patients. From the remaining patients, we identified 12,587 comparison patients without trigeminal neuralgia by propensity score matching, using sex, age, monthly income, geographic region, residential urbanization level, and tinnitus-relevant comorbidities (hyperlipidemia, diabetes, coronary heart disease, hypertension, cervical spondylosis, temporomandibular joint disorders and injury to head and neck and index year). All study patients (n = 25,174) were tracked for a one-year period to identify those with a subsequent diagnosis of tinnitus over 1-year follow-up.ResultsAmong total 25,174 sample patients, the incidence of tinnitus was 18.21 per 100 person-years (95% CI = 17.66 ~ 18.77), the rate being 23.57 (95% CI = 22.68 ~ 24.49) among patients with trigeminal neuralgia and 13.17 (95% CI = 12.53 ~ 13.84) among comparison patients. Furthermore, the adjusted Cox proportional hazard ratio for tinnitus in the trigeminal neuralgia group was 1.68 (95% CI = 1.58 ~ 1.80) relative to the comparison cohort.ConclusionsWe found a significantly increased risk of tinnitus within 1 year of trigeminal neuralgia diagnosis compared to those without the diagnosis. Further studies in other countries and ethnicities are needed to explore the relationship between trigeminal neuralgia and subsequent tinnitus.
Highlights
Tinnitus is the auditory phantom sensation of sound in the absence of external stimuli
Trigeminal neuralgia, like other pain disorders of the head and neck region such as temporomandibular disorders (TMD) and cervical spine disorders (CSD), is thought to be associated with transmission of nociceptive inputs through the trigeminal nerve which converge with other somatosensory pathways in the brainstem [17,18,19]
Among the total 25,174 sample patients, incidence of tinnitus was 18.21 per 100 person-years, 23.57 among the trigeminal neuralgia group, and 13.17 among the comparison group
Summary
Database Data for this study was accessed from the Taiwan National Health Insurance Research Dataset (NHIRD). We excluded 1859 patients less than 18 years of age, and 118,357 patients who had received a diagnosis of tinnitus (ICD-9-CM code 388.3) within the year prior to the index date. The selected trigeminal neuralgia (study) cohort included 12,587 patients. The index year for patients of the study cohort was the year when they first received the diagnosis of trigeminal neuralgia, and the date was their index date. We further screened the comparison patients to exclude those who had ever received a diagnosis of tinnitus in the year prior to their index date. Patient (n = 25,174) were tracked for a one-year period following their index date to identify any claim with a diagnosis of tinnitus. Cox proportional hazards regression analysis was used to estimate the one-year adjusted risk of tinnitus following trigeminal neuralgia. Adjusted hazard ratio (HR) along with 95% confidence intervals (CI) was used to estimate the risk of tinnitus, with a two-sided p value < 0.05 considered as statistically significant
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