Tinnitus and Stress: Can Anxiety Cause Ringing in the Ears?

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Ringing in the ears, known as tinnitus, can be more than just an annoyance; it can severely impact daily life. For those affected, the persistent noise is overwhelming and frustrating. Adding to this burden is the often-overlooked connection between tinnitus and anxiety. This link creates a vicious cycle where stress worsens tinnitus, making both conditions harder to manage.

The connection between tinnitus (ringing in the ear) and anxiety

Anxiety doesn’t directly cause tinnitus but can play a significant role in its development and severity.

How anxiety can contribute to tinnitus

Anxiety attacks can sometimes trigger tinnitus:

Increased sensitivity: Anxiety heightens your awareness of bodily sensations. When you’re anxious, you might notice the humming or buzzing in your ears, making it seem louder and more persistent.
Stress response: Anxiety triggers the release of stress hormones like cortisol. ¹ These hormones can affect blood flow and nerve function, raising stress levels and worsening tinnitus.
Muscle tension: Anxiety often causes muscle tension around the neck, jaw, and shoulders. This tension can affect the auditory system and worsen tinnitus symptoms.

How tinnitus can lead to anxiety

Constant noise: Tinnitus’s persistent ringing can be distressing and lead to increased anxiety. The more you focus on the noise, the more anxious you may become.
Sleep disruption: Tinnitus can interfere with sleep, causing fatigue and increased stress. Poor sleep quality can also contribute to higher anxiety.
Concentration issues: The ongoing noise can make concentrating difficult, leading to frustration and anxiety about daily tasks.

How do you know your ringing ear is caused by anxiety

Determining if your tinnitus is related to anxiety involves observing your symptoms and their triggers. Here are some key indicators that anxiety might be causing or worsening your ringing ears:

Timing and triggers

Stressful situations: If your tinnitus worsens during or after stressful events, anxiety might be the cause.
Relaxation periods: Notice if the ringing decreases when you are relaxed or less anxious. This could indicate a link to anxiety.
Daily patterns: Check if your tinnitus is more noticeable during busy or stressful times and less noticeable during calm periods.

Physical symptoms

Muscle tension: Anxiety can cause muscle tension in your neck, jaw, and shoulders. If your tinnitus is accompanied by muscle tension, anxiety might be involved.
Heart rate: Anxiety increases your heart rate. If your tinnitus worsens when your heart is racing or you feel panicked, anxiety could be the cause.
Headaches: Frequent headaches or migraines can come with anxiety and may make tinnitus worse.

Emotional correlation

Mood changes: If the ringing in your ears gets louder or more bothersome when you’re anxious, stressed, or worried, anxiety could be the cause.
Sleep patterns: Anxiety can disturb your sleep. If your tinnitus worsens when you have insomnia or disturbed sleep, this might indicate a link to anxiety.
Irritability: Increased irritability or mood swings can also be a sign that anxiety is affecting your tinnitus.

Professional evaluation

Medical check-up: See a healthcare provider to rule out other causes of tinnitus, like ear infections or hearing loss. If no other causes are found, anxiety might be the reason.
Mental health assessment: A mental health professional can assess your anxiety levels and see if they are affecting your tinnitus. They can also suggest ways to manage anxiety and reduce tinnitus.
Hearing tests: An audiologist can conduct hearing tests to check for issues that might be contributing to tinnitus.

Personal insights

Self-monitoring: Journal your tinnitus symptoms, anxiety levels, and stressors. This can help you spot patterns that link anxiety to tinnitus.
Feedback from others: Friends or family might notice changes in your behavior or mood that you haven’t. Their observations can help determine if anxiety is affecting your tinnitus.
Mindfulness practices: Try mindfulness or meditation and see if these techniques reduce your tinnitus symptoms when your anxiety is managed.

What else might cause tinnitus?

Tinnitus, or ringing in the ears, can be caused by various factors other than anxiety. Here are some common causes:

Hearing loss

Age-related hearing loss: As you age, the structures in your inner ear can deteriorate, leading to hearing loss and tinnitus. ²
Noise-induced hearing loss: Exposure to loud noises, either from a single intense event or long-term exposure, can damage the hair cells in your ear, causing tinnitus. ³

Ear infections and ear canal blockages

Ear infections: Infections in the middle ear can cause fluid buildup and inflammation, leading to tinnitus.
Earwax buildup: Excess earwax can block the ear canal, causing pressure and tinnitus.
Eustachian tube dysfunction: The tube that connects your middle ear to your throat can become blocked or not open properly, causing tinnitus.

Medications

Ototoxic drugs: Certain medications, such as antibiotics, diuretics, and cancer medications, can cause or worsen tinnitus. ⁴
Aspirin and NSAIDs: High doses of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to tinnitus. ⁴

Health conditions

Meniere’s disease: This inner ear disorder causes vertigo, hearing loss, and tinnitus due to abnormal inner ear fluid pressure.
TMJ disorders: Tinnitus can be caused by problems with the temporomandibular joint, which connects the jaw to the skull.
High blood pressure: Hypertension and factors that increase blood pressure, like stress, alcohol, and caffeine, can make tinnitus more noticeable.
Diabetes: High blood sugar levels can damage the nerves in the inner ear, leading to tinnitus.
Thyroid problems: Both hypothyroidism and hyperthyroidism can cause tinnitus.

Head and neck injuries

Trauma: Injuries to the head or neck can affect the auditory nerves, blood flow, or inner ear structures and trigger tinnitus.

Other causes

Acoustic neuroma: A benign tumor on the auditory nerve can cause tinnitus in one ear.
Blood vessel disorders: Conditions like atherosclerosis or an abnormal blood vessel can cause pulsatile tinnitus, which is when you hear your heartbeat in your ears.
Dietary factors: High salt intake, alcohol, and caffeine can worsen tinnitus symptoms.

How to treat tinnitus & anxiety disorder

Treating tinnitus and anxiety disorder often involves a combination of approaches to address both conditions. Here are some methods to consider:

Medical treatments

For tinnitus

Hearing aids: If hearing loss is causing your tinnitus, hearing aids can help improve hearing and reduce the ringing sensation.
Sound therapy: White noise machines, specialized ear devices, or sound-masking apps can help drown out tinnitus and make it less noticeable.
Medications: Certain medications, such as antidepressants or antianxiety drugs, may help reduce the severity of tinnitus in some individuals.

For anxiety disorder

Antidepressants and Anti-Anxiety Medications: Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are commonly prescribed to help manage anxiety symptoms.
Beta-Blockers: These can help control physical symptoms of anxiety, such as rapid heart rate, which might also reduce the perception of tinnitus.

Behavioral therapies

Cognitive behavioral therapy (CBT): CBT can help you change negative thought patterns and behaviors related to both tinnitus and anxiety. This therapy can teach you coping skills to manage the stress and anxiety that tinnitus can cause.
Mindfulness-based stress reduction (MBSR): This program incorporates mindfulness meditation and yoga to help reduce stress and improve your response to anxiety and tinnitus.
Tinnitus retraining therapy (TRT): TRT combines sound therapy with counseling to help you habituate to the tinnitus and reduce its impact on your daily life.

Alternative therapies

Acupuncture: Some people find relief from tinnitus and anxiety symptoms through acupuncture, which involves inserting thin needles into specific points on the body.
Herbal supplements: Supplements like ginkgo biloba, melatonin, and valerian root sometimes help with tinnitus and anxiety. Always consult with a healthcare provider before starting any supplement.

Lifestyle Changes

Exercise: Regular physical activity can help reduce anxiety and improve overall well-being. Exercise can also distract you from tinnitus and help you sleep better.
Healthy diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health and reduce anxiety symptoms. Avoiding caffeine, alcohol, and high salt intake can also help manage tinnitus.
Sleep hygiene: Establish a regular sleep routine by going to bed and waking up at the same time every day. Ensure your sleep environment is quiet, dark, and comfortable. Good sleep hygiene can help reduce both tinnitus and anxiety symptoms.

Relaxation techniques

Deep breathing: Practicing deep breathing exercises can help calm your nervous system and reduce anxiety, which might also lessen the perception of tinnitus.
Progressive muscle relaxation: This technique involves tensing and then slowly relaxing different muscle groups in your body, helping to reduce overall tension and anxiety.
Yoga and meditation: Incorporating yoga and meditation into your daily routine can help reduce stress and anxiety and relieve tinnitus symptoms.

Final thoughts

Living with tinnitus and anxiety can be incredibly challenging. The persistent ringing in your ears and the stress of anxiety can create a difficult cycle to break.

If you find that your tinnitus worsens with stress and anxiety, or if anxiety seems to be a trigger, it’s important to address both issues together.

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Sources

1. Lenze, E. J., Mantella, R. C., Shi, P., Goate, A. M., Nowotny, P., Butters, M. A., Andreescu, C., Thompson, P. A., & Rollman, B. L. (2011). Elevated cortisol in older adults with generalized anxiety disorder is reduced by treatment: A placebo-controlled evaluation of escitalopram. American Journal of Geriatric Psychiatry, 19(5), 482-490. https://doi.org/10.1097/JGP.0b013e3181ec806c

2. National Institute on Aging. (2023, January 19). Hearing loss: A common problem for older adults. Retrieved from https://www.nia.nih.gov/health/hearing-and-hearing-loss/hearing-loss-common-problem-older-adults

3. National Institute on Deafness and Other Communication Disorders. (2022, March 16). Noise-induced hearing loss. Retrieved from https://www.nidcd.nih.gov/health/noise-induced-hearing-loss

4. Ulrich, A., & Murdock, J. (2022, April 22). Medications that can cause ringing in the ears (tinnitus). GoodRx. Retrieved from https://www.goodrx.com/drugs/side-effects/these-11-prescriptions-may-cause-ringing-in-the-ears

Author: Editorial Team
JULY 23, 2024