Purpose: We used a representative older population-based cohort to establish the predictors and impacts of tinnitus. Methods: A total of 1,214 participants of the Blue Mountains Hearing Study were followed for 5 years (1997 - 1999 to 2002 - 2004). The presence of tinnitus was assessed by an audiologist-administered questionnaire. Hearing impairment was defined as the pure tone average (PTA)0.5-4KHz > 25 dB HL, in the better ear. Quality of life was measured by use of the Short Form 36-item Health Survey (SF-36). Depression was assessed using either the SF-36 (Mental Health Index, subscale) and the Center for Epidemiologic Studies Depression Scale. Results: Symptomatic dizziness and hearing loss were significant risk factors for incident tinnitus, multivariable-adjusted odds ratio, 2.41 (95% confidence interval, 1.62-3.58) and odds ratio 2.31 (95% confidence interval, 1.46-3.66), respectively. Incident tinnitus cases demonstrated significantly lower mean SF-36 scores compared with subjects without tinnitus and were more likely to be depressed as assessed by both the Mental Health Index and Center for Epidemiologic Studies Depression Scale. Conclusions: Incident tinnitus was predicted by two otological risk factors, dizziness and hearing loss. Temporal data documented diminished quality of life and psychological well-being in those subjects experiencing tinnitus. This finding highlights the importance of effective intervention strategies to prevent potentially debilitating morbidity associated with tinnitus.