A National Cohort Study of Tinnitus and Hearing Loss in the Million Veteran Program

OBJECTIVES: To characterize the prevalence, severity, and correlates of hearing loss and tinnitus in U.S. Veterans enrolled in the Million Veteran Program, and, secondarily, to contextualize audiometric patterns relative to an age-matched civilian cohort. DESIGN: Retrospective cross-sectional cohort study. Audiometric thresholds and word recognition scores were analyzed for 267,395 Veterans (1999-2021) with linked demographics and self-reported health data. Findings were compared descriptively with 40,912 adults from a clinical cohort at Massachusetts Eye and Ear. Primary outcomes included the prevalence of hearing loss and tinnitus, age- and sex-specific audiometric thresholds, word recognition in quiet, and associations between tinnitus and selected comorbidities. RESULTS: Among 267,395 Veterans (94% male), 86% had hearing loss and 47% reported tinnitus. In multivariable models, word recognition was independently associated with older age and worse hearing thresholds. Because Veterans with tinnitus were younger for a given degree of hearing loss, word recognition scores were similar between groups when adjusting for hearing thresholds alone; however, after accounting for age, Veterans with tinnitus showed slightly poorer word recognition. Tinnitus prevalence was higher among Veterans with traumatic brain injury or concussion and among those reporting anxiety or depression, with smaller increases associated with sleep disturbance and alcohol use. Tobacco use showed no association with tinnitus prevalence. African American Veterans had better hearing thresholds and lower tinnitus prevalence than other racial groups, whereas Asian Veterans showed greater hearing loss at older ages. Compared with the civilian cohort, Veterans showed earlier and greater hearing loss, particularly at 4 kHz. Men showed greater high-frequency loss, whereas women showed steeper low-frequency declines at older ages. CONCLUSIONS: Hearing loss and tinnitus are highly prevalent among VA healthcare-using Veterans and appear to occur earlier and with greater severity than in a clinic-based civilian cohort. These patterns, including the occurrence of tinnitus in some individuals with preserved audiometric thresholds and subtle suprathreshold deficits, are consistent with mechanisms such as cochlear nerve degeneration that are not captured by conventional audiometry. The findings highlight the need for improved diagnostic approaches for suprathreshold auditory dysfunction, objective measures of tinnitus, and integrated clinical care addressing both auditory and neuropsychiatric comorbidities. The Million Veteran Program cohort provides a powerful platform for future studies examining the biological and genetic determinants of hearing loss and tinnitus.