Tinnitus and Tinnitus Disorder: Theoretical and Operational Definitions (An International Multidisciplinary Proposal)

Dirk De Ridder, University of Otago
Winfried Schlee, University of Regensburg
Sven Vanneste, Trinity College Dublin
Alain Londero, Hôpital Européen Georges Pompidou
Nathan Weisz, University of Salzburg
Tobias Kleinjung, University of Zurich
Giriraj Singh Shekhawat, Flinders University
Ana Belén Elgoyhen, Instituto de Investigaciones en Ingeniería Genética y Biología Molecular "Dr. Héctor N. Torres" (INGEBI)
Jae-Jin Song, Seoul National University College of Medicine
Gerhard Andersson, Linköping University
Divya Adhia, University of Otago
Andreia Aparecida de Azevedo, otorrinolaringologia Sul Fluminense
David M. Baguley, University of Nottingham
Eberhard Biesinger, Centre of Otorhinolaryngology
Ana Carolina Binetti, Buenos Aires British Hospital
Luca Del Bo, Del Bo Tecnologia per l'ascolto srl
Christopher R. Cederroth, Nottingham University Hospitals NHS Trust
Rilana Cima, Maastricht University
Jos J. Eggermont, University of Calgary
Ricardo Figueiredo, Centro Universitário de Valença
Thomas E. Fuller, Maastricht University
Silvano Gallus, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
Annick Gilles, Antwerp University Hospital
Deborah A. Hall, University of Nottingham


As for hypertension, chronic pain, epilepsy and other disorders with particular symptoms, a commonly accepted and unambiguous definition provides a common ground for researchers and clinicians to study and treat the problem. The WHO's ICD11 definition only mentions tinnitus as a nonspecific symptom of a hearing disorder, but not as a clinical entity in its own right, and the American Psychiatric Association's DSM-V doesn't mention tinnitus at all. Here we propose that the tinnitus without and with associated suffering should be differentiated by distinct terms: "Tinnitus" for the former and "Tinnitus Disorder" for the latter. The proposed definition then becomes "Tinnitus is the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes Tinnitus Disorder "when associated with emotional distress, cognitive dysfunction, and/or autonomic arousal, leading to behavioural changes and functional disability.". In other words "Tinnitus" describes the auditory or sensory component, whereas "Tinnitus Disorder" reflects the auditory component and the associated suffering. Whereas acute tinnitus may be a symptom secondary to a trauma or disease, chronic tinnitus may be considered a primary disorder in its own right. If adopted, this will advance the recognition of tinnitus disorder as a primary health condition in its own right. The capacity to measure the incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address acute tinnitus as a symptom but chronic tinnitus as a disorder.