Clin Exp Otorhinolaryngol.  2018 Dec;11(4):242-249. 10.21053/ceo.2017.01641.

Urine Cotinine Should Be Involved in Initial Evaluation of Tinnitus in Adolescents

• Lee DY
• Kim YH

• KMID: 2439850
• DOI: http://doi.org/10.21053/ceo.2017.01641

Abstract

OBJECTIVES
Smoking is associated with hearing loss, while the correlation between tinnitus and smoking is not fully elucidated. This study aimed to evaluate risk factors of tinnitus in adolescents in terms of smoking, and we identified a rectifiable parameter that can be serially monitored.
METHODS
A cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey, with 2,782 participants aged 12 to 18 years, from 2008 through 2011. Participants with history of ear disease, hearing loss, and inadequate responses to questionnaires were excluded. We investigated the prevalence of tinnitus and tinnitus-related annoyance by questionnaire and sought potential risk factors in blood and urine tests and smoking history.
RESULTS
The prevalence of tinnitus in the 12- to 18-year-old population was 17.5%, with 3.3% reporting tinnitus-related annoyance. On univariate analysis, the prevalence of tinnitus increased with age (P < 0.001) and was higher among girls (P=0.012). Blood tests and urinalysis showed significant correlation between tinnitus and red blood cell count, alkaline phosphatase levels, and urine cotinine (P=0.002, P < 0.001, P=0.018, respectively). In multivariate analysis, the urine cotinine level was the only parameter associated with tinnitus (odds ratio, 1.000; 95% confidence interval, 0.999 to 1.000; P=0.038). Smoking was also significantly correlated with tinnitus (P=0.043), and amount of smoking with tinnitus-related annoyance (P=0.045). However, current smoking and past smoking were not correlated with tinnitus.
CONCLUSION
Urine cotinine may be a rectifiable marker for management of tinnitus in adolescents. This suggests that smoking cessation should be incorporated in the management of tinnitus in adolescents.

Keyword

Tinnitus; Annoyance; Smoking; Cotinine

MeSH Terms

Adolescent*
Alkaline Phosphatase
Cotinine*
Cross-Sectional Studies
Ear Diseases
Erythrocyte Count
Female
Hearing Loss
Hematologic Tests
Humans
Korea
Multivariate Analysis
Nutrition Surveys
Prevalence
Risk Factors
Smoke
Smoking
Smoking Cessation
Tinnitus*
Urinalysis
Alkaline Phosphatase
Cotinine
Smoke

Figure

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  Fig. 1. Study population. a)Not mutually exclusive.

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  Fig. 2. Prevalence of smoking and tinnitus in each age group. The prevalence of tinnitus increased with age (P<0.001), as did the proportion of smokers (P<0.001), albeit with some fluctuation.

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  Fig. 3. Variation in urine cotinine levels by smoking history (A) and sex (B), and correlation between amount smoked, tinnitus, and tinnitus-related annoyance in smokers (C). (A, B) Participants with tinnitus showed higher urine cotinine levels than those without tinnitus in all subgroups, which reached statistical significance in the total cohort and in smokers and boys. (C) Although development of tinnitus was not associated with the amount smoked, tinnitus-related annoyance was significantly correlated with amount smoked.

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