Discover the complex relationship between tinnitus and anxiety. Learn how these conditions affect each other and what you can do to manage them effectively.
Dr Edmund Farrar

Dr Edmund Farrar

Medically Reviewed by
Co-Founder & CEO of Oto

The connection between tinnitus and anxiety you don’t know

Are you constantly plagued by a ringing sound in your ears that no one else can hear? Does this symptom exacerbate your anxiety levels? If so, you're not alone. Evidence suggests that 45% of people with chronic tinnitus also exhibit symptoms of anxiety [1]. While they may appear to be disparate issues, emerging research is shedding light on a compelling connection between the two. Understanding this link is crucial for effective management and treatment of both ailments. Hence, this article explores the scientific relationship between these two conditions, providing you with practical guidance and remedies.

The science behind the anxiety-tinnitus connection

The relationship between tinnitus and anxiety isn't merely anecdotal; it's backed by a wealth of scientific research. Let's delve into the specifics to offer you a well-rounded understanding.

Neurological links

Tinnitus is often linked to the auditory system, but it's not just an ear issue. The brain's limbic system, responsible for emotions like anxiety, also plays a crucial role. More specifically, when you're anxious, the limbic system becomes more active, amplifying the symptoms experienced.

Psychological factors

Anxiety disorders often co-occur with tinnitus. According to a study published in Neuropsychiatric Disease and Treatment, individuals with chronic tinnitus had higher anxiety sensitivity scores compared to those without tinnitus [2]. This suggests that anxiety doesn't just worsen the auditory condition; it might also serve as a contributing element.

The stress response

When you're anxious, your body releases stress hormones like cortisol, sending the body into “fight or flight” mode. Elevated cortisol levels can heighten your senses, making the ringing more noticeable. Plus, this creates a vicious cycle: the more you focus on it, the more worried you become, and vice versa.

Impact on quality of life

Both tinnitus and anxiety can severely impact your quality of life. The constant perception of sound can lead to sleep disturbances, concentration issues, and social withdrawal. These factors, in turn, can escalate anxiety levels, making it imperative to address both conditions simultaneously.

Coping strategies for tinnitus and anxiety

Managing both tinnitus and anxiety can be a challenging feat, but there are several coping strategies that can make a significant difference. Below is an in-depth guide to assist you in navigating these health challenges effectively:

Relaxation techniques

  • Deep breathing exercises: Draw a deep breath in through your nose, pause for a brief moment, and then release the air gently out of your mouth. Repeat this process for 5 to 10 minutes to help reduce stress levels and shift focus away from the persistent auditory distress.
  • Progressive muscle relaxation: Begin with your toes and work your way up, tensing and relaxing each muscle group for 5 to 10 seconds. This technique not only reduces anxiety but also helps in focusing away from the ringing in your ears.
  • Guided imagery: Close your eyes and imagine serene landscapes or situations. Use all your senses to immerse yourself in the imagery, which can help reduce tension and lessen your awareness of the auditory symptoms.

Mindfulness practices

  • Meditation: Sit in a comfortable position, close your eyes, and focus on your breath. Whenever your mind wanders to the buzzing in your ears or troubled thoughts, gently bring it back to your breathing rhythm.
  • Yoga: Incorporate yoga into your daily routine. The combination of physical postures, breathing exercises, and meditation can be highly effective in managing your agitation.

Sleep hygiene

  • Regular sleep schedule: For effective symptom management, regularise your sleep schedule by going to bed and waking up at consistent times. Incorporate calming activities, like reading or a warm bath, to help your body prepare for rest.
  • Sleep environment: Ensure your bedroom is dark, quiet, and cool. Consider using white noise machines to mask the sound of tinnitus and promote better sleep.

Sound therapy

  • Description: Sound therapy employs tailored sound frequencies to enhance mental and physical health. Often used for conditions like stress or tinnitus, this approach involves hearing selected tones through headphones or speakers to divert attention from discomforting sensations like buzzing or ringing in the ears. It can be customised and may be used alongside other treatments for greater effectiveness.
  • Benefits: By using external sounds to mask the internal noise of tinnitus, this therapy can divert your attention. Additionally, calming sounds can help reduce anxiety levels, creating a dual benefit.

  • Types of sounds: You can use white noise, nature sounds, or even calming music as part of the therapy. Some people prefer binaural beats, which involve playing two slightly different frequencies in each ear to create a perceived third tone that can be calming. There's no one-size-fits-all solution, so don't stress about finding the "perfect" sound or frequency. The goal is to find a sound that helps you push tinnitus to the background and reduces your awareness of it, allowing you to focus on your life.
  • Implementation: Various devices like sound machines, smartphone apps, or even YouTube videos can be used for easy implementation. For a more targeted approach, consult a healthcare provider who can tailor the therapy to your specific needs.
  • Duration: The effectiveness of sound therapy can vary from person to person. What's most important is to find a duration that feels comfortable and helps you achieve a sense of calm. Whether you find solace in shorter bursts of sound or prefer longer, immersive sessions, the choice is entirely yours.

Cognitive Behavioural Therapy for tinnitus and anxiety

Cognitive Behavioural Therapy (CBT) stands as a cornerstone in the effective management of both tinnitus and anxiety. Here’s how:

Core principles

One of the transformative aspects of CBT is its ability to alter the brain's automatic emotional reactions to tinnitus. Often, when tinnitus triggers feelings of anxiety, the brain perceives the sound as a threat. This activates a protective mechanism, causing you to constantly notice and think about the sound, thereby perpetuating a cycle of anxiety and heightened awareness of tinnitus. 

Through various techniques and exercises, CBT helps you change how your brain perceives the sound, shifting it from a perceived threat to a neutral or non-disruptive element. This change in perception allows you to stop noticing the sound as much, effectively breaking the cycle of anxiety and intrusive awareness of tinnitus.

Cognitive restructuring

One of the pivotal techniques employed in CBT is cognitive restructuring. This involves dissecting and challenging ingrained negative thoughts and replacing them with more constructive and realistic alternatives. For instance, instead of thinking, "This ringing will never stop, and I can't handle it," you might reframe it to, "The ringing is annoying, but I have strategies to cope with it."

Conscious breathing

By focusing on the breath, individuals can cultivate a sense of calm and mindfulness. This practice allows for a shift in perception, helping the brain reclassify the tinnitus sound from a perceived threat to a neutral stimulus. Over time, this can reduce the emotional weight attached to the tinnitus sound, making it less intrusive and more manageable.

The role of medications in coping with tinnitus and anxiety

When it comes to the role of medication, the landscape is complex yet crucial. Various medicines, such as Selective Serotonin Reuptake Inhibitors (SSRIs) are generally effective only if there is a diagnosed generalised anxiety disorder or co-existing anxiety and depression. They are not designed to provide direct relief from tinnitus symptoms. Rather, they aim to manage the broader emotional landscape that might be exacerbating the perception of tinnitus. 

It's generally advised to consider medication as a last resort, particularly when symptoms severely interfere with daily life. This recommendation is especially relevant when other treatments like CBT have proven ineffective. Always consult a healthcare provider for a tailored treatment plan, keeping in mind that medication is often most effective when used for short periods and in conjunction with other therapies.

Lifestyle changes to manage tinnitus and anxiety

Beyond coping mechanisms and medication, embracing specific lifestyle changes can positively impact your management of tinnitus and anxiety:

Dietary adjustments

Consider revising your diet to include foods rich in antioxidants and vitamins while reducing the intake of stimulants like caffeine and alcohol. These changes can not only alleviate anxiety but also contribute to better sleep quality.

Trigger management

Identifying and avoiding triggers is key. For tinnitus, this often means steering clear of loud environments, such as concerts or construction sites. Similarly, for anxiety, avoiding stressful situations or specific phobias, like heights or crowded spaces, can be beneficial. Awareness and planning ahead can not only help in immediate symptom relief but also contribute to long-term well-being.

Noise reduction

As also highlighted above, reducing exposure to loud noises is paramount for tinnitus management, as prolonged exposure can exacerbate symptoms. Invest in high-quality ear protection and be mindful of the volume levels when listening to music or watching TV.

Regular exercise

Incorporating regular exercise into your routine can have multiple benefits. Physical activity releases endorphins, which act as natural mood boosters, helping to reduce anxiety levels. Exercise can also serve as a distraction from tinnitus symptoms and contribute to better sleep quality.

Spending time outside

Spending time in natural settings can have a calming effect on both the mind and body. The tranquillity of nature can help push tinnitus to the background and reduce anxiety. Whether it's a walk in the park or a hike in the mountains, the positive impact of spending time outdoors should not be underestimated.

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Transform your relationship with tinnitus and anxiety through Oto

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What is Oto?

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How does Oto work?

Oto utilises the power of CBT, which has proven to be highly effective in tuning out tinnitus. To this end, the platform offers guided audio sessions that feel like you're speaking directly to a therapist. These sessions last anywhere from three to thirty minutes and are designed to give you the mental toolkit to live peacefully with tinnitus. The program adapts to each individual's needs, providing a highly personalised experience. It can also be accessed anytime, anywhere, bringing the necessary support right to your fingertips.

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Navigating the complexities of tinnitus and anxiety can be a daunting task, but understanding the science behind the connection, exploring coping strategies, and considering various approaches can make a world of difference. 

However, the journey to tuning out tinnitus and reducing its impact on your life doesn't have to be a solitary one. Oto stands as a beacon of hope and as your companion, offering a digital program with a 96% success rate. With its user-friendly interface and expert-crafted content, Oto is designed to help you push tinnitus to the background and reclaim your peace of mind. 

Ready to take the first step towards a life less disrupted by tinnitus and anxiety? Download the Oto app now and begin your transformative experience today.


1. Belli, H., Oktay, M. F., & Ural, C. (2012). Psychopathological dimensions of tinnitus and psychopharmacologic approaches in its treatment. General Hospital Psychiatry, 34(3), 282-289. DOI: 10.1016/j.genhosppsych.2011.12.006

2. Gül, A. I., Özkırış, M., Aydin, R., Şimşek, G., & Saydam, L. (2015). Coexistence of anxiety sensitivity and psychiatric comorbidities in patients with chronic tinnitus. Neuropsychiatric disease and treatment, 11, 413–418.

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