A recent study published in the American Journal of Otolaryngology (“An Association between Marijuana use and Tinnitus”) sought to determine the association between marijuana use and tinnitus.1

An Overview of Tinnitus

Tinnitus is a relatively common condition, affecting 10-15% of adult Americans at any given point in time. Most people will experience some degree of tinnitus during their lifetime. The risk of experiencing tinnitus increases with age and is more prevalent in men. 2,3,4,5,6

It is important to note that tinnitus is a symptom, not a disease. This means that although tinnitus can cause varying degrees of distress in the affected individual, that its presence alone isn’t indicative of any specific condition, rather it can be used as an indicator for further investigation into the multitude of etiologies that may cause it. Some examples of conditions that can cause tinnitus include: tumors, infections, and otosclerosis (the overgrowth of the stapes, a bone located within the middle ear, that can lead to loss of sound conduction). Some examples of risk factors that can lead to tinnitus include age, gender, exposure to loud noises, cigarette smoking, hypertension, cardiovascular disease, and diabetes.

Tinnitus can be thought of as hearing sound that hasn’t been created by any external source. Those affected can experience a sense of whistling, ringing, buzzing, pulsating, or hissing in their ear. Tinnitus can affect either one or both ears and can be constant in nature or occur intermittently.

The prognosis for tinnitus is generally favorable, with approximately 80% of acute (short-term) cases resolving either spontaneously or with treatment. However, for chronic (long-term) cases, only about 25% will achieve full resolution of this symptom.2,3,4,5,6

The Study

Prior to this study, the relationship between marijuana use and tinnitus had only been examined through animal models such as laboratory rats. This is the first study to explore the relationship between marijuana use and tinnitus in humans. In particular, it was created to evaluate the association between marijuana use and the prevalence, severity, and frequency of tinnitus by analyzing data from the 2011-2012 edition of the National Health and Nutrition Examination Survey (NHANES).

Methods

The NHANES is a large survey that is representative of the national (US) population. Statistical analysis was performed on the 2011-2012 edition of this survey, which included 2705 non-institutionalized civilian adults from the ages of 20-69.

The individuals examined in this study had been administered audiometric testing to assess their hearing capabilities. They were also given questionnaires concerning hearing, medication and drug use, current health status, and prior medical and audiological history.

Use of marijuana, salicylates (i.e., aspirin), alcohol, recreational drugs, history of noise exposure, cigarette smoking, cardiovascular disease, hypertension, diabetes, and anxiety reported by those selected for the study were also all taken into account using the data provided in the survey. Prior literature has suggested that these variables mentioned above have been potential risk factors for tinnitus. Researchers attempted to control for confounding data by assessing the presence of these variables within the lives of the people selected from the survey. Confounding data is something researchers try to avoid at all costs, as it can skew the validity of a study. The presence (and potential influence) of confounding data is particularly tantamount to the validity of this study as researchers wanted to specifically determine the relationship between marijuana and tinnitus, as opposed to alcohol and tinnitus, for example.

After pertinent data was collected, it was then evaluated using multiple forms of statistical analysis.

The particular type of study model used in the analysis of this data is referred to as “cross-sectional.” Cross-sectional studies are those in which the prevalence of a disease (or condition of interest) and other variables such as risk factors are measured simultaneously at a specific point in time, focusing on a snapshot of the population at this time. Prevalence refers to the number of people with both new and pre-existing conditions throughout a certain period.

Findings

Statistical analysis of the data indicated that the use of marijuana at least once a month for 12 consecutive months had a strong association with experiencing tinnitus during the 12 months.

It was found that tinnitus present in marijuana users was not associated with frequency or quantity of use.

Marijuana use was also not associated with tinnitus severity or frequency of occurrence. It was also noted that there was no dose-response relationship seen regarding the severity of tinnitus and frequency of marijuana use, the severity of tinnitus and the quantity of marijuana use, frequency of tinnitus occurrence, and frequency of marijuana use, and frequency of tinnitus occurrence and quantity of marijuana use.

After controlling for covariables associated with tinnitus that could act as potential confounders by using a technique called multivariate analysis, regular marijuana use still displayed a strong association with tinnitus.

The study concluded by stating that, based on the nationally representative sample used, it was found that regular marijuana use is associated with prevalent tinnitus (after controlling for covariables that were also associated with tinnitus).

Drawbacks and Limitations

There will always be limitations present when attempting to ascertain associations among selected data categories through the “cross-sectional” technique of analysis used in this study. However, this particular study was presented with some unique challenges.

Firstly, there is no “standardization” of marijuana. There exists a multitude of cannabis variants available for consumption that have different chemical makeups and, therefore, may cause different reactions in those who consume them. Additionally, individuals who may consume the same marijuana variant containing 100% of the same chemical components theoretically may still experience different reactions due to the unpredictable nature of how this substance uniquely affects each individual that consumes it.

In regards to the cross-sectional nature of this study, any associations that can be made will all inherently be correlative rather than causative. This limits the ability for it to determine if, for example, marijuana causes increased tinnitus if tinnitus causes increased marijuana use, or if an extrinsic factor (such as anxiety) causes both increased marijuana use and tinnitus.1

The authors of this study noted that although there was certainly an association between marijuana use and tinnitus, the ability to truly understand the nature of this association likely requires a detailed understanding of the complex interaction between marijuana, tinnitus, and psychological factors that exist within the individual. This information is currently unavailable anywhere within the scientific literature.

To this point, the authors state that a dose-response relationship between marijuana use and tinnitus would have provided highly valuable insight in regards to the nature of this association. However, because no such finding was found within this study, this key piece of potential understanding was not ascertained.

Final thoughts

According to the authors, this is the first study on the association between marijuana use and tinnitus in humans. The strength of this study was in its large sample size taken from the NHANES survey as well as the diverse characteristics of the patients selected.

This study is certainly a step forward towards our understanding of some of the potential negative drawbacks of marijuana use. However, regarding its association with tinnitus, much more research is needed before we can reach a firm conclusion.

Bibliography:

  1. Qian, Z. Jason, and Jennifer C. Alyono. “An Association between Marijuana Use and Tinnitus.” American Journal of Otolaryngology , vol. 41, no. 1, Jan. 2020, p. 102314., doi:10.1016/j.amjoto.2019.102314.
  2. Benson AG, Meyers AD. Tinnitus. In: Tinnitus. New York, NY: WebMD. http://emedicine.medscape.com/article/856916. Updated April 26, 2017.
  3. Vestibular Disorders Association. What is that Ringing in my Ears?. https://vestibular.org/tinnitus. Updated January 1, 2007.
  4. American Tinnitus Association. Demographics. https://www.ata.org/understanding-facts/demographics. Updated January 1, 2016
  5. American Academy of Otolaryngology-Head and Neck Surgery. Tinnitus. http://www.entnet.org/content/tinnitus<. Updated January 1, 2017.
  6. Centers for Disease Control and Prevention. National Health and Nutrition Examination: Survey 2011-2012 Data Documentation, Codebook, and Frequencies: Audiometry. https://wwwn.cdc.gov/nchs/nhanes/2011-2012/AUQ_G.htm. Updated December 1, 2013.

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