(870) Perceived Hearing Difficulties and Tinnitus Despite Normal Hearing Thresholds: Exploring Psychosocial and Metabolic Correlates

Introduction: Hearing difficulty and tinnitus can impair quality of life, with many adults reporting these symptoms despite normal audiometric thresholds. This study examined whether demographic, audiometric, lifestyle, and health-related factors are associated with perceived hearing difficulty and tinnitus in adults with normal hearing.

Methods: We conducted a cross-sectional analysis of adults aged 20-69 years with normal pure tone averages (PTA) using 2015-2018 National Health and Nutrition Examination Survey (NHANES) data. Hearing difficulty and tinnitus were self-reported. Covariates included age, sex, race/ethnicity, education, smoking history, balance issues, pain or functional limitations, and select health measures. Survey-weighted multivariable logistic regression examined associations between hearing difficulty and covariates and, separately, between tinnitus and covariates, adjusting for age, sex, and PTA. Results are reported as odds ratios (OR) with 95% confidence intervals (CI), with p < 0.05 considered statistically significant.

Results: Tinnitus was strongly associated with hearing difficulty (adjusted OR 3.55, 95% CI 2.21–5.71, p < 0.001). Participants reporting balance issues or difficulty with daily activities due to pain or other limitations were more likely to report hearing difficulty (adjusted OR 0.71, 95% CI 0.51–0.99, p = 0.045; OR 0.73, 95% CI 0.61–0.86, p < 0.001, respectively). Age, sex, PTA, and select health measures were not significantly associated with hearing difficulty. Conversely, hearing difficulty was associated with tinnitus (adjusted OR 3.58, 95% CI 1.61–7.97, p = 0.002). No other variables were significantly associated with tinnitus.

Conclusions: Even in adults with normal hearing thresholds, perceived hearing difficulties and tinnitus are closely linked, and balance and functional limitations contribute to these difficulties. These findings emphasize the importance of evaluating psychosocial and functional factors in patients presenting with auditory symptoms despite normal audiometry.