Tinnitus, diet and healthy ageing
Despite the high prevalence of tinnitus, its exact aetiology remains unclear. Research has explored the role of various biological pathways in the development of tinnitus including age-related changes in the auditory system, impaired vascular function, inflammation, oxidative stress and disruptions in neural signalling. According to a systematic review and meta-analysis by Mennink et al evaluating nine animal studies and 20 human studies, there is evidence of inflammatory-vascular pathways in tinnitus [1].
Observations have reported elevated proinflammatory cytokines in animals and humans with tinnitus, activated microglial and astrocytes in the region of the auditory cortex and brainstem, as well as platelet activation. In older adults with tinnitus, a clinical follow-up study of 233 patients showed that those with tinnitus had more severe chronic heart failure and a significantly higher risk of one-year mortality and hospitalisation for chronic heart failure [2]. The authors speculate that the development or worsening of tinnitus may be indirectly associated with haemodynamic instability in chronic heart failure and irregularities in inner ear circulation, causing a decrease in systemic blood pressure.
As ageing is one of the most consistent risk factors for tinnitus, healthy ageing may be key to reducing burden of tinnitus. According to the World Health Organisation, healthy ageing is “the process of developing and maintaining the functional ability that enables wellbeing in older age” [3]. Diet is a known determinant of healthy ageing, with established benefits in cardiovascular, metabolic and cognitive health. Given that many proposed biological mechanisms of tinnitus overlap with these systems, research attention has unsurprisingly turned to understanding the role modifiable lifestyle factors including diet in the prevention of tinnitus.
Figure 1: Overview of measures collected in the Blue Mountains Hearing Study.
The Blue Mountains Hearing Study
In Australia, the Blue Mountains Hearing Study was one of the largest population-based cohort studies on hearing health in the country [4–6]. It followed 1217 adults aged 50 years and older residing in the Blue Mountains area of Sydney, Australia, over a 10-year period (1997–1999 to 2007–2009). Collecting a wide range of data, as shown in Figure 1, the analyses examined the links between various health measures and the five- and 10-year risk of developing tinnitus. Significant non-dietary risk factors included poorer hearing and cochlear function, self-reported work-related noise exposure and history of middle ear or sinus infections, severe neck injury or migraine. For the dietary data, this was collected via a 145-item food frequency questionnaire, which had been validated against weighed food records – the gold standard for dietary assessment.
Findings revealed that only lower intakes of zinc, iron, fruit fibre and cereal fibre increased the risk of developing tinnitus by 35–65% [4–6]. Interestingly, ‘lower intake’ of iron from the Blue Mountains data was an intake ≤ 9.51 mg/d, which actually exceeds the recommended daily intake (RDI) for both men and women aged over 50 years (8 mg/d). Comparatively, a lower zinc intake (≤ 8.48 mg/d) aligned with the RDI for women (8 mg/d) but fell short of the RDI for men (14 mg/d). While Australia does not have a specific RDI for different types of fibre, the overall RDI for fibre is 25 g/d for women and 30 g/d for men over the age of 50, which well exceeds the lower intake levels considered ‘at risk’ for tinnitus.
Overall, the Blue Mountains Hearing Study has provided interesting insights into the associations between tinnitus and diet. However, the last point of data collection was over 15 years ago and, in the time since, dietary patterns have likely changed and the demographics of the Australian population may no longer be comparable to those of the study participants. Our current research was initiated due to this need for newer data to explore whether these risk factors are still relevant.
Designing a risk model for tinnitus
Through funding from an American Tinnitus Association Grant (2025), a project is currently underway to derive a risk model to develop and pilot an online tinnitus risk quiz in middle-to-older aged adults living in Australia. Phase 1 of this study will identify statistically significant and clinically relevant tinnitus risk factors for middle-to-older aged adults using population-based longitudinal data from the Blue Mountains Hearing Study, findings from global literature and input from a project advisory group. Specifically, the team will complete analysis of the Blue Mountains’ data to identify all the significant risk factors associated with incident tinnitus in the studied population to derive a predictive model to estimate an individual’s level of tinnitus risk. Accounting for the limitations of using the Blue Mountains dataset, a literature search will be conducted to triangulate new evidence for risk factors of incident tinnitus not assessed in the Blue Mountains Hearing Study. Discussions with the project advisory group will determine the relevant risk factors to include in online risk quiz prototype.
Figure 2: Example of the ‘Test My Tinnitus Risk’ quiz dashboard that could be developed utilising a traffic light display.
Phase 2 of this project is focused on the development and testing of the online risk quiz. The online quiz will be co-designed by the project advisory group, research team and IT experts at Macquarie University. Through this collaboration, the team will determine all aspects of this quiz, including the wording of questions and responses, the overall design and the presentation of results. For example, the output quiz may feature a personalised risk dashboard that highlights specific risk factors alongside an overall risk score, or level as shown in Figure 2. Personalised information could then be provided with links to more information about the specific risk factors, support information and nearby healthcare professionals.
The quiz prototype will be evaluated using the ‘Think Aloud’ technique in which participants are asked to complete the quiz and verbalise their thoughts and reactions as they do so. Immediately following completion of the ‘Think-Aloud’ session, each participant will complete an audio-recorded semi-structured interview. This interview provides an opportunity to obtain a more nuanced understanding of participants’ experiences with the quiz, to clarify any thoughts or reactions expressed by participants during the ‘Think-Aloud’ session, and to provide feedback such as suggestions for modifications or areas that could be improved.
"The quiz aims to raise awareness... to reduce the risk of tinnitus and support better management"
The intention is for the resulting quiz to serve as a public health resource and be hosted on a public platform such as Hear4Health – a website for unbiased hearing health information that is currenting under development by our team with funding from the Australian National Health and Medical Research Council (#2029190).
Summary
The Blue Mountains Hearing Study was a large Australian cohort study that found that lower intakes of zinc, iron, fruit fibre and cereal fibre increased the risk of developing tinnitus by 35–65%. Building on the evidence of this 10-year study, current work will triangulate different sources of data – such as research databases, individuals with lived experience and clinicians – to identify tinnitus risk factors and develop an online tinnitus risk quiz. The quiz aims to raise awareness, offer personalised insights and connect people with relevant supports to reduce their risk of tinnitus and support better management.
References
1. Mennink LM, Aalbers MW, van Dijk P, et al. The Role of Inflammation in Tinnitus: A Systematic Review and Meta-Analysis. J Clin Med 2022;11(4):1000.
2. Borghi C, Cosentino ER, Rinaldi ER, et al. Tinnitus in elderly patients and prognosis of mild-to-moderate congestive heart failure: a cross-sectional study with a long-term extension of the clinical follow-up. BMC Med 2011;9:80.
3. World Health Organization. Healthy ageing and functional ability.
https://www.who.int/news-room/questions
-and-answers/item/healthy-ageing-
and-functional-ability?utm_source=chatgpt.com
[Link last accessed December 2025].
4. Tang D, Shekhawat GS, Burlutsky G, et al. The Association between Dietary Intakes of Vitamins and Minerals with Tinnitus. Nutrients 2024;16(15):2535.
5. Tang D, Tran Y, Shekhawat GS, et al. Dietary Fibre Intake and the 10-Year Incidence of Tinnitus in Older Adults. Nutrients 2021;13(11):4126.
6. Tang D, Tran Y, Lewis JR, et al. Associations between intake of dietary flavonoids and the 10-year incidence of tinnitus in older adults. Eur J Nutr 2022;61(4):1957–64.
Declaration of competing interests: DT has been awarded a research grant (2025–2026) from the American Tinnitus Association.
