Risk of Stroke in Emergency Department Patients Presenting with Tinnitus

Introduction: Recent literature has demonstrated a potential relationship between tinnitus and cerebrovascular events. We seek to determine the risk of cerebrovascular accidents (CVAs) in patients who present to the emergency department (ED) with tinnitus.

Methods: A retrospective review of the National Emergency Department Sample from 2020 and 2021 was conducted. Patient and hospital characteristics were compared for those who presented to the ED for a tinnitus diagnosis with and without CVA.

Results: Of the 37,086 patients presenting with a diagnosis of tinnitus (H93.x), 1,851 (5%) were diagnosed with a CVA (I6x). Patients diagnosed with a CVA were often older (66 years old vs 51, p< 0.001), male (52% vs 48%, p< 0.001), white (62% vs 54%, p< 0.001) and more likely to get admitted (79% vs 23%, p< 0.001). Patients diagnosed with a CVA had significantly higher rates of imaging (12% vs 6%, p< 0.001). Interestingly, these patients had significantly lower rates of standard head computed tomography (CT) utilization (1% vs 24%, p< 0.001) but higher utilization of dedicated stroke imaging such as CT angiography (12% vs 6%, p< 0.001) and magnetic resonance imaging (13% vs 6%, p< 0.001). Patients with a CVA had significantly higher costs associated with both their ED encounter and total hospitalization ($10,050 vs $6,572, p< 0.001; $86,078 vs $72,751, p=0.0001). Patients concomitantly presenting with complaints of dizziness (R42) and/or headache (R51) were significantly less likely to have a CVA (OR 0.81, 95%CI [0.71-0.9]; OR 0.44 [0.37-0.52], respectively).

Conclusions: While a small portion of patients with tinnitus who present to the emergency department are ultimately diagnosed with a CVA, there are higher rates in the older, white males compared to the general population. We also demonstrate common associated diagnoses such as dizziness and headache to be negative predictors of CVAs.