Tinnitus — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 84 of 2020

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting tinnitus or death from tinnitus with the circumstances of a person's relevant service:

1. (1)
   being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical onset of tinnitus;

   Note: dB(C) is defined in the Schedule 1 - Dictionary.

2. (2)
   being exposed to a sound pressure level at the tympanic membrane of at least 85 dB(A) as an 8-hour time-weighted average (TWA) with a 3-dB exchange rate for a cumulative period of at least six months before the clinical onset of tinnitus;

   Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 - Dictionary.

3. (3)
   having blunt trauma, penetrating trauma or surgery to an auditory structure or central auditory neural pathway, within the five years before the clinical onset of tinnitus;

   Note: Examples of trauma include temporal bone fracture and basilar skull fracture.

   Note: auditory structure is defined in the Schedule 1 - Dictionary.

4. (4)
   having sensorineural hearing loss or conductive hearing loss at the time of the clinical onset of tinnitus;
5. (5)
   taking a drug from the specified list of drugs within the 30 days before the clinical onset of tinnitus;

   Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

6. (6)
   taking a drug which is associated in the individual with: (a) the development of tinnitus within 30 days of commencing drug therapy; and (b) a decrease in tinnitus within days or weeks of discontinuing or tapering drug therapy; and where treatment with the drug continued for at least the three days before the clinical onset of tinnitus;
7. (7)
   having smoked at least ten pack-years of tobacco products before the clinical onset of tinnitus, and where smoking has ceased, the clinical onset of tinnitus has occurred within five years of cessation;

   Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

8. (8)
   being exposed to second-hand smoke: (a) for at least 2,500 hours before the clinical onset of tinnitus; and (b) where the first exposure to second-hand smoke commenced at least five years before the clinical onset of tinnitus; and (c) where the last exposure to second-hand smoke occurred within the two years before the clinical onset of tinnitus;

   Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

9. (9)
   having inner ear exposure to a chemical agent from the specified list of chemical agents within the 30 days before the clinical onset of tinnitus;

   Note: Inner ear exposure to a chemical agent will only occur in the presence of a defect in the tympanic membrane.

   Note: specified list of chemical agents is defined in the Schedule 1 - Dictionary.

10. (10)
    having a vascular, muscular or other anatomical source of sound that can be transmitted to the affected ear at the time of the clinical onset of tinnitus;

    Note: vascular, muscular or other anatomical source of sound is defined in the Schedule 1 - Dictionary.

11. (11)
    having a reduced supply of blood to an auditory structure of the affected ear at the time of the clinical onset of tinnitus;

    Note: Examples of causes of a reduced supply of blood to an auditory structure include coagulation disorders, embolism, thrombosis, haemorrhage or vasospasm of the vertebro-basilar circulation, hyperviscosity, vasculitis, and intralabyrinthine haemorrhage or infarction.

    Note: auditory structure is defined in the Schedule 1 - Dictionary.

12. (12)
    having a bone disease from the specified list of bone diseases, affecting the petrous temporal bone or middle ear ossicles of the affected side, at the time of the clinical onset of tinnitus;

    Note: specified list of bone diseases is defined in the Schedule 1 - Dictionary.

13. (13)
    having osteoporosis at the time of the clinical onset of tinnitus;
14. (14)
    having an autoimmune disease at the time of the clinical onset of tinnitus;
15. (15)
    having multiple sclerosis at the time of the clinical onset of tinnitus;
16. (16)
    having a benign or malignant neoplasm involving the petrous temporal bone, an auditory structure or central auditory neural pathway of the affected ear at the time of the clinical onset of tinnitus;

    Note: auditory structure is defined in the Schedule 1 - Dictionary.

17. (17)
    having a haematological disease from the specified list of haematological diseases at the time of the clinical onset of tinnitus;

    Note: specified list of haematological diseases is defined in the Schedule 1 - Dictionary.

18. (18)
    having a cerebrovascular accident within the 30 days before the clinical onset of tinnitus;
19. (19)
    having concussion or moderate to severe traumatic brain injury within the three months before the clinical onset of tinnitus;
20. (20)
    being exposed to an explosive blast within the 30 days before the clinical onset of tinnitus;
21. (21)
    being struck by lightning within the 30 days before the clinical onset of tinnitus;
22. (22)
    having temporomandibular disorder at the time of the clinical onset of tinnitus;
23. (23)
    having trigeminal neuralgia at the time of the clinical onset of tinnitus;
24. (24)
    having migraine or tension-type headache before the clinical onset of tinnitus;
25. (25)
    having Meniere's disease or delayed endolymphatic hydrops at the time of the clinical onset of tinnitus;
26. (26)
    having: (a) an episode of otitic barotrauma involving the affected ear; or (b) cerebral arterial gas embolism; or (c) decompression sickness; within the 30 days before the clinical onset of tinnitus;

    Note: Otitic barotrauma is also known as otic barotrauma.

27. (27)
    having acoustic shock at the time of the clinical onset of tinnitus;

    Note: acoustic shock is defined in the Schedule 1 - Dictionary.

28. (28)
    having a bacterial infection from the specified list of bacterial infections within the 30 days before the clinical onset of tinnitus;

    Note: specified list of bacterial infections is defined in the Schedule 1 - Dictionary.

29. (29)
    having a viral infection from the specified list of viral infections within the 30 days before the clinical onset of tinnitus;

    Note: specified list of viral infections is defined in the Schedule 1 - Dictionary.

30. (30)
    having meningitis or encephalitis within the one year before the clinical onset of tinnitus;
31. (31)
    having neurosyphilis before the clinical onset of tinnitus;
32. (32)
    having tuberculosis involving the nasopharynx, meninges, temporal bone, middle ear or inner ear of the affected side before the clinical onset of tinnitus;
33. (33)
    having typhoid fever within the 30 days before the clinical onset of tinnitus;
34. (34)
    undergoing a course of therapeutic radiation for cancer, where the auditory apparatus was in the field of radiation, before the clinical onset of tinnitus;
35. (35)
    having: (a) a cobalt-containing metal-on-metal hip prosthesis; or (b) a serum cobalt concentration of at least 200 micrograms per litre; for at least the four weeks before the clinical onset of tinnitus;
36. (36)
    having vitamin B1 (thiamine) or vitamin B12 (cobalamin) deficiency at the time of the clinical onset of tinnitus;
37. (37)
    having carbon monoxide poisoning within the 48 hours before the clinical onset of tinnitus;
38. (38)
    having hypothyroidism for at least the three months before the clinical onset of tinnitus;
39. (39)
    having a clinically significant depressive disorder or a clinically significant anxiety disorder at the time of the clinical onset of tinnitus;

    Note: clinically significant is defined in the Schedule 1 - Dictionary.

40. (40)
    being exposed to a peak sound pressure level at the tympanic membrane of at least 140 dB(C) before the clinical worsening of tinnitus;

    Note: dB(C) is defined in the Schedule 1 - Dictionary.

41. (41)
    being exposed to a sound pressure level at the tympanic membrane of at least 85 dB(A) as an 8-hour time-weighted average (TWA) with a 3-dB exchange rate for a cumulative period of at least six months before the clinical worsening of tinnitus;

    Note: dB(A) and time-weighted average (TWA) with a 3-dB exchange rate are defined in the Schedule 1 - Dictionary.

42. (42)
    having blunt trauma, penetrating trauma or surgery to an auditory structure or central auditory neural pathway, within the five years before the clinical worsening of tinnitus;

    Note: Examples of trauma include temporal bone fracture and basilar skull fracture.

    Note: auditory structure is defined in the Schedule 1 - Dictionary.

43. (43)
    having sensorineural hearing loss or conductive hearing loss at the time of the clinical worsening of tinnitus;
44. (44)
    taking a drug from the specified list of drugs within the 30 days before the clinical worsening of tinnitus;

    Note: specified list of drugs is defined in the Schedule 1 - Dictionary.

45. (45)
    having smoked at least ten pack-years of tobacco products before the clinical worsening of tinnitus, and where smoking has ceased, the clinical worsening of tinnitus has occurred within five years of cessation;

    Note: pack-year of tobacco products is defined in the Schedule 1 - Dictionary.

46. (46)
    being exposed to second-hand smoke: (a) for at least 2,500 hours before the clinical worsening of tinnitus; and (b) where the first exposure to second-hand smoke commenced at least five years before the clinical worsening of tinnitus; and (c) where the last exposure to second-hand smoke occurred within the two years before the clinical worsening of tinnitus;

    Note: being exposed to second-hand smoke is defined in the Schedule 1 - Dictionary.

47. (47)
    having inner ear exposure to a chemical agent from the specified list of chemical agents within the 30 days before the clinical worsening of tinnitus;

    Note: Inner ear exposure to a chemical agent will only occur in the presence of a defect in the tympanic membrane.

    Note: specified list of chemical agents is defined in the Schedule 1 - Dictionary.

48. (48)
    having a vascular, muscular or other anatomical source of sound that can be transmitted to the affected ear at the time of the clinical worsening of tinnitus;

    Note: vascular, muscular or other anatomical source of sound is defined in the Schedule 1 - Dictionary.

49. (49)
    having a reduced supply of blood to an auditory structure of the affected ear at the time of the clinical worsening of tinnitus;

    Note: Examples of causes of a reduced supply of blood to an auditory structure include coagulation disorders, embolism, thrombosis, haemorrhage or vasospasm of the vertebro-basilar circulation, hyperviscosity, vasculitis, and intralabyrinthine haemorrhage or infarction.

    Note: auditory structure is defined in the Schedule 1 - Dictionary.

50. (50)
    having a bone disease from the specified list of bone diseases, affecting the petrous temporal bone or middle ear ossicles of the affected side, at the time of the clinical worsening of tinnitus;

    Note: specified list of bone diseases is defined in the Schedule 1 - Dictionary.

51. (51)
    having osteoporosis at the time of the clinical worsening of tinnitus;
52. (52)
    having an autoimmune disease at the time of the clinical worsening of tinnitus;
53. (53)
    having multiple sclerosis at the time of the clinical worsening of tinnitus;
54. (54)
    having a benign or malignant neoplasm involving the petrous temporal bone, an auditory structure or central auditory neural pathway of the affected ear at the time of the clinical worsening of tinnitus;

    Note: auditory structure is defined in the Schedule 1 - Dictionary.

55. (55)
    having a haematological disease from the specified list of haematological diseases at the time of the clinical worsening of tinnitus;

    Note: specified list of haematological diseases is defined in the Schedule 1 - Dictionary.

56. (56)
    having a cerebrovascular accident within the 30 days before the clinical worsening of tinnitus;
57. (57)
    having concussion or moderate to severe traumatic brain injury within the three months before the clinical worsening of tinnitus;
58. (58)
    being exposed to an explosive blast within the 30 days before the clinical worsening of tinnitus;
59. (59)
    being struck by lightning within the 30 days before the clinical worsening of tinnitus;
60. (60)
    having temporomandibular disorder at the time of the clinical worsening of tinnitus;
61. (61)
    having trigeminal neuralgia at the time of the clinical worsening of tinnitus;
62. (62)
    having migraine or tension-type headache before the clinical worsening of tinnitus;
63. (63)
    having Meniere's disease or delayed endolymphatic hydrops at the time of the clinical worsening of tinnitus;
64. (64)
    having: (a) an episode of otitic barotrauma involving the affected ear; or (b) cerebral arterial gas embolism; or (c) decompression sickness; within the 30 days before the clinical worsening of tinnitus;

    Note: Otitic barotrauma is also known as otic barotrauma.

65. (65)
    having acoustic shock at the time of the clinical worsening of tinnitus;

    Note: acoustic shock is defined in the Schedule 1 - Dictionary.

66. (66)
    having a bacterial infection from the specified list of bacterial infections within the 30 days before the clinical worsening of tinnitus;

    Note: specified list of bacterial infections is defined in the Schedule 1 - Dictionary.

67. (67)
    having a viral infection from the specified list of viral infections within the 30 days before the clinical worsening of tinnitus;

    Note: specified list of viral infections is defined in the Schedule 1 - Dictionary.

68. (68)
    having meningitis or encephalitis within the one year before the clinical worsening of tinnitus;
69. (69)
    having neurosyphilis before the clinical worsening of tinnitus;
70. (70)
    having tuberculosis involving the nasopharynx, meninges, temporal bone, middle ear or inner ear of the affected side before the clinical worsening of tinnitus;
71. (71)
    having typhoid fever within the 30 days before the clinical worsening of tinnitus;
72. (72)
    undergoing a course of therapeutic radiation for cancer, where the auditory apparatus was in the field of radiation, before the clinical worsening of tinnitus;
73. (73)
    having: (a) a cobalt-containing metal-on-metal hip prosthesis; or (b) a serum cobalt concentration of at least 200 micrograms per litre; for at least the four weeks before the clinical worsening of tinnitus;
74. (74)
    having vitamin B1 (thiamine) or vitamin B12 (cobalamin) deficiency at the time of the clinical worsening of tinnitus;
75. (75)
    having carbon monoxide poisoning within the 48 hours before the clinical worsening of tinnitus;
76. (76)
    having hypothyroidism for at least the three months before the clinical worsening of tinnitus;
77. (77)
    having a clinically significant depressive disorder or a clinically significant anxiety disorder at the time of the clinical worsening of tinnitus;

    Note: clinically significant is defined in the Schedule 1 - Dictionary.

78. (78)
    inability to obtain appropriate clinical management for tinnitus;

Aggravation-only factors: the factors in subsections 9(40) to 9(78) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.