Tinnitus and Anxiety

What Is Tinnitus?

Tinnitus, commonly referred to as ringing in the ears, is identified by sounds within the ears that only the individual can hear (phantom sounds). Although these audio signals frequently present as ringing, they may sound like whooshing, buzzing, chirping, hissing, whispering, singing, or, in rare cases, shrieking.

Tinnitus is estimated to affect about 10–25% of the general adult population,¹ although the prevalence is difficult to track due to inconsistency in defining and reporting tinnitus.² Many people with tinnitus live with the condition without needing to seek medical care or treatment; however, for many others, tinnitus symptoms can be debilitating and can lead to depression, anxiety, insomnia, and overall reduced quality of life.² It appears that fewer than 7% of people with tinnitus experience severely debilitating symptoms.¹

Although in many cases no determinate cause can be found, tinnitus can occur due to a physical condition, such as a buildup of earwax; the use of certain medications,³ such as high doses of non-steroidal anti-inflammatory drugs or some antibiotics; or tightening of the jaw muscles. Additionally, researchers have found that certain conditions, such as stress, depression, or anxiety may trigger tinnitus or worsen it. It is estimated that 26 percent of those with tinnitus also suffer from anxiety.⁴

What Is Anxiety?

Anxiety can be described as uneasiness, worry, or fear over the unfamiliar or unknown.⁵ Anxious feelings can occur in relation to a specific issue, such as an upcoming event, or may be more generalized if an individual is unsure of what is happening in the present or what will happen in the future. Producing both emotional and physical responses from the body, anxiety can also increase a person’s stress levels overall.

It is important to note that while nearly everyone experiences anxiety occasionally, if someone has an anxiety disorder, they experience excessive worry or fear that interferes with their functioning in interpersonal, school, work, or other situations.⁵ Whether or not there is a real threat, just the perception of a dangerous situation can cause worry or fear. This can lead to sweating, increased blood pressure and heart rate, and excess levels of the stress hormone called cortisol.

Living with an anxiety disorder can keep someone under persistent stress, keeping the body in fight-or-flight mode as the individual stays ready for potential danger. When the body and mind remain alert and under constant pressure, this activates what is known as stress-response hyperstimulation.⁶ Also referred to as hyperarousal, this state may make a person more aware of anything out of the ordinary, increasing stress levels and anxiety even further.

The Relationship Between Tinnitus and Anxiety

There is a strong association between tinnitus and anxiety.⁴ According to a recent study, 45 percent of those affected by tinnitus have also experienced an anxiety disorder in their lifetime.⁷ Similar areas of the brain appear to be activated in those who experience tinnitus and in those with anxiety.⁸ Whether the activation of these areas by tinnitus triggers anxiety symptoms or vice versa remains unknown.

Because someone who lives with an anxiety disorder may experience stress-response hyperstimulation, it is believed that the hyperarousal may make tinnitus sounds more apparent to an anxious or stressed individual, whereas those audio cues may not be noticed otherwise. Additionally, someone experiencing a panic attack may have increased blood flow throughout the body, including the auditory canal, potentially increasing the chance of tinnitus. Conversely, tinnitus can increase anxiety in susceptible people. Anxiety sensitivity may contribute to higher levels of tinnitus distress.⁹

Further, hyperacusis and phonophobia may often occur together in people with tinnitus. Hyperacusis refers to decreased ability to tolerate certain normal sounds and noises or having an exaggerated response to such noises. Phonophobia refers to the arousal of negative emotions, such as anxiety, by certain sounds. Unconscious association patterns have been attributed to theoretical causes for these conditions.⁸

Treatments for Tinnitus

When tinnitus has a known physical cause, it can usually be improved by treating the underlying issue. For example, a physician can remove hardened earwax or a cyst. Switching medications when possible has also been shown to reduce tinnitus symptoms. When tightening the jaw muscles is to blame, massage or ultrasound therapy may help.¹⁰

An audiologist may also determine if there’s an issue in the ear canal, such as restriction in blood vessels or a tumor, that may cause tinnitus. In that case, surgical intervention may be warranted to treat the medical issue, which may also result in ameliorating the tinnitus and preventing or reducing the progression of hearing loss.

Psychotherapeutic modalities, including the following, may be helpful for some people: ^{9,11,12,13,14}

• cognitive behavioral therapy
• tinnitus retraining therapy
• relaxation training
• acoustic stimulation
• hypnosis

These therapies help to reduce the client’s awareness of the condition and the sounds. Combining cognitive behavioral therapy, sound therapy, and education seems to show promising results.¹³ Mindfulness and acceptance-based modalities may also help people find some relief.

While many pharmacological medications have been studied as potential treatments for tinnitus, the evidence supporting their effectiveness remains low.¹

Repetitive transcranial magnetic stimulation is another therapeutic modality that has been studied for its effectiveness for tinnitus, but the results are inconclusive.¹

Can Treatments for Anxiety Help With Tinnitus?

Anxiety is commonly treated with medication, counseling, or both. Although no medication has been approved by the FDA for treating tinnitus, some antianxiety and antidepressant medications have been shown to help people feel less stressed and possibly even make the auditory signals less noticeable.¹⁵

Psychotherapeutic methods can also help individuals with co-existing tinnitus and anxiety. Cognitive behavioral therapy can treat both hyperacusis and phonophobia relatively effectively.⁹

Since similar areas of the brain may be affected by both tinnitus and anxiety, it is possible that reducing apprehension or worry may also help to alleviate unwanted auditory sensations, but further research is needed to determine this. Because stress levels often correlate with the onset of tinnitus, learning mindfulness and relaxation techniques can help those affected cope with stressful situations and potentially reduce tinnitus symptoms.