Improving sensitivity of tinnitus screening in hearing conservation programs

Abstract: INTRODUCTION: Tinnitus is prevalent among U.S. military Service Members (SMs). Current Department of Defense (DOD) Hearing Conservation Program (HCP) protocols use a standardized annual screening question to identify bothersome tinnitus. However, this question fails to distinguish transient ear noise-a benign, short-lived auditory phenomenon-from tinnitus. The Department of Veterans Affairs (VA)/DOD Tinnitus Working Group consequently modified the screening question to integrate symptom duration, frequency, and impact on life. The purpose of this study was to evaluate whether the modified screening question improves identification of SMs who require referral for tinnitus evaluation and management. Secondary aims examined how responses to both screening questions aligned with validated tinnitus questionnaires, referral preferences, and diagnostic outcomes. MATERIALS AND METHODS: This observational study included 4,922 SMs screened for tinnitus during routine HCP visits at Kimbrough Ambulatory Care Center, Fort Meade, MD and was approved by the Defense Centers for Public Health-Aberdeen. Participants answered the current annual screening question (Question A: "During the past month, how much have you been bothered by noises in your head or ears, such as ringing, buzzing, crickets, humming, or a tone?") and the VA/DOD question (Question B: "Do you have noises in your ears or head that occur at least twice a week and last for 5 or more minutes that affect your ability to concentrate, sleep, and/or affect your mood?"). Those indicating they were bothered in response to Question A or B completed the Tinnitus and Hearing Survey-Tinnitus Subscale (THS-T) and the Tinnitus Functional Index (TFI). A subset of participants answered 2 referral questions and another subset was evaluated by an audiologist. Statistical analysis included non-parametric tests (Wilcoxon, Kruskal-Wallis, Dunn's post-hoc), Welch's t-tests, and sensitivity/specificity analysis, performed in RStudio v4.5.0. RESULTS: Of SMs who reported being "bothered a little" on Question A, 56% responded "no" to the more specific Question B, indicating they may be bothered by transient ear noise. Sensitivity and specificity were found to be 98% and 94%, respectively, for individuals who responded "yes" and were either "bothered a little" or "bothered a lot" to Question B. These results indicated that Question B better identified clinically significant tinnitus needing referral. Among those who underwent audiological evaluation based on Question A response, 28.6% were determined to have transient ear noise and over half received tinnitus-related interventions. Service members requesting referral had significantly higher THS-T and TFI scores than those who did not (P < .001), further validating the clinical relevance of self-reported impact. CONCLUSIONS: The modified tinnitus screening question more accurately identifies individuals requiring referral to audiology for tinnitus evaluation and management, improving referral accuracy and reducing unnecessary clinical workload. Strengths of the study include its large sample size, use of validated instruments, and real-world clinical integration. Limitations include incomplete follow-through data on referred SMs because of decentralized care access. Findings support the replacement of the current question with the modified version and incorporating brief validated questionnaires (e.g., THS-T) and self-reported referral interest to improve triage.