Stress and tinnitus are interrelated in such a way that they profoundly impact each other: When stress increases, tinnitus does as well; when tinnitus increases, stress likewise tends to increase.‍ But what is the connection between these two conditions and how can they be managed?‍ Oto presents an in-depth guide about stress and tinnitus, and what can be done to keep both in check.

Alexandra Costlow, AuD

Medically Reviewed by
Dr Jameel Muzaffar
Audiologist and Tinnitus Specialist
October 29, 2021

Tinnitus and Stress: The Oto Guide For A Calmer Mind

Stress and tinnitus are interrelated in such a way that they profoundly impact each other:  When stress increases, tinnitus does as well; when tinnitus increases, stress likewise tends to increase.

But what is the connection between these two conditions and how can they be managed?

Oto presents an in-depth guide about stress and tinnitus, and what can be done to keep both in check.

Tinnitus And Stress

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
Tinnitus and stress are both common conditions but there is treatment for both.

Tinnitus and stress are both common conditions: tinnitus prevalence is estimated to be between 4-20% and the concept of stress is perceived globally.

What is stress, exactly? Per Very Well Mind, "Stress can be defined as any type of change that causes physical, emotional, or psychological strain. Stress is your body's response to anything that requires attention or action."

Everyone experiences stress to some degree. The way you respond to stress, however, makes a significant difference to your overall well-being.

Which comes first, tinnitus or stress? It doesn't so much matter which comes first as both are manageable conditions and improving one may also improve the other.

For stress management, consider the following effective stress relievers:

  • Cognitive Behavioral Therapy or other forms of counseling
  • Mindfulness, meditation, progressive muscle relaxation, guided imagery, or other exercises
  • Practicing self-care, including getting enough sleep, eating a well-balanced diet, and making time for leisure
  • Practice yoga or exercise
  • Engage in hobbies such as arts and crafts, reading, writing, or music
  • Consider seeking guidance from a psychologist, counselor, medical doctor, or other qualified mental health professional

For improving tinnitus, safe and effective treatments include:

Tinnitus: The Sound Of Stress

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
The limbic system regulates the depth of the emotional response to perceiving tinnitus.

How does stress influence tinnitus? Tinnitus has been described as the sound of stress.

Tinnitus and stress can be demonstrated as a "vicious cycle": when tinnitus occurs it can evoke feelings of annoyance, anger, despair, sadness, and loss of control. These feelings can lead to stress, which can in turn make tinnitus seem worse.

The vicious cycle of tinnitus is explained by the neurophysiological model of tinnitus that begins with a change in hearing, followed by an awareness of or attention to the change in hearing, and finally, the change in hearing is perceived as a threat to safety by the limbic system (emotional response). The depth of the emotional response is driven by the limbic system, and calming this response is key to improving tinnitus severity.

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
First the tinnitus is perceived, then your ability to cope suffers, which leads to an increase in stress and unhelpful behaviours. The vicious cycle persists until it is interrupted.

One technique you can use to interrupt the vicious cycle is to challenge your thoughts and beliefs about tinnitus: Is the tinnitus in fact louder? Doesn't it always get softer or go away?

Are your thoughts and emotions about tinnitus helpful or even conducive to improving the tinnitus? Consider what is under your control to improve your tinnitus.

Pulsatile Tinnitus Due To Stress

Pulsatile tinnitus may occur with stress, but it should never be assumed that pulsatile tinnitus is caused by stress. If you notice pulsatile tinnitus, you should consult a general practitioner for medical evaluation whether or not you also feel stressed.

Causes of pulsatile tinnitus include but are not limited to:

  • Hypertension, or high blood pressure
  • Atherosclerosis, or hardening of the arteries
  • Turbulent blood flow due to vascular formations, abnormal connections between arteries and veins
  • Benign or Idiopathic Intracranial Hypertension (BIH/ IIH) also referred to as pseudotumor cerebri, which is high pressure in the fluid that surrounds the brain
  • Head and neck tumors
  • Other causes

Given the possible causes of pulsatile tinnitus, it's important to seek medical evaluation when pulsatile tinnitus occurs with or without stress. If the pulsatile tinnitus is determined to be benign and it occurs when you feel stressed, an important part of treatment will be managing stress.

Does Stress Make Tinnitus Worse?

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
Identifying stressors that cause tinnitus to seem worse is the first step in understanding the connection between tinnitus and stress.

First, let's establish that nearly everyone experiences stress at least at some point in their life, and usually, stress exists on a continuum: some days you may feel mildly stressed by a temporary event like a road closure on your way to work, and other days you may feel profound stress due to multiple stressors such as work, family, health, and finances.

Acute stress can arise from stressors, which are events or things that cause you to feel stressed. Examples of stressors include but are not limited to:

  • Pressure at work and/or school
  • Finances
  • Demands of home or family life
  • Health conditions or exacerbations thereof
  • Not having enough time to complete self care or important tasks
  • Experiencing negative events

How To Manage Stress

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
CBT is a safe and effective treatment to manage anxiety and stress.

The first step in managing stress is to identify your stressors and then to think about how you feel when you experience them. It can be helpful to consider how you might think or feel differently about them such that you are able to re-categorize the stressors as neutral or non-threatening.

A safe and effective therapy for changing your thoughts and emotions about stressors (including tinnitus) is Cognitive Behavioral Therapy (CBT). The components of CBT include:

  1. Becoming aware of your thoughts and emotions.
  2. Challenging your thoughts and emotions.
  3. Reframing negative thoughts and emotions as neutral or non-threatening.

There are several questions you can ask yourself to evaluate your thoughts and emotions:

  1. What evidence exists to support your thoughts and emotions? 
  2. What evidence exists to challenge your thoughts end emotions? 
  3. What advice would you give to a good friend in the same position?
  4. Are your thoughts and emotions helpful?

By becoming aware of and in control of your thoughts and emotions, you will improve your ability to manage stress. This sense of awareness and control can also help relieve anxiety.

Can Stress Cause Temporary Tinnitus?

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
Tinnitus may be temporarily louder, more noticeable, or change in quality due to a stressful event.

Stress can indeed cause temporary tinnitus and it can exacerbate existing tinnitus. You may notice your tinnitus is louder, occurs more frequently, or changes in pitch or quality during a stressful time or event.

Positively, tinnitus should soften and eventually the end goal is habituation. An important tool in managing tinnitus is to identify and avoid or manage triggers as much as reasonably possible.

It's important to remember that the tinnitus should return to baseline and you should be able to ignore it after the stressful event has passed. If the tinnitus persists or worsens, it may be time to find professional tinnitus help.

Stress is an inevitable part of life so the better that you are able to manage stress, the better off you will be in terms of also managing tinnitus. Likewise, the better control you have over your tinnitus, the less it will cause additional stress to you.

Avoiding And Managing Triggers

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
Practicing mindfulness can help you feel more in control of your tinnitus and stress.

An important step in reducing stress is to avoid and manage triggers. Once you are able to identify your triggers, you can adapt your lifestyle to minimize the likelihood of encountering them.

It may be impossible to completely avoid triggers and as such, it's important to have a plan to manage stress when life throws curveballs. Practicing mindfulness based stress reduction can be a powerful tool for feeling at peace. Consider the seven fundamental attitudes for practicing mindfulness according to Jon Kabat Zinn:

  1. Acceptance: Being present in the moment and taking things as they are.
  2. Non-judging: Let thoughts and feelings come and go without categorizing or valuing them.
  3. Patience: Approach things with compassion and control, don't let the ego take over, and accept that there is a life cycle to things.
  4. Letting go: This is another way of phrasing non-attachment to views and ideas.
  5. Trust: Using attention and awareness to trust your own perception of what is happening in your environment and your feelings about it.
  6. Beginner's Mind: Approach each experience as if it was the first time you are encountering it. Think of a child experiencing an apple for the first time. Do not allow thinking to get in the way of the experience.
  7. Non-striving: Accept where you are as opposed to striving for results or an outcome.

Will Stress Related Tinnitus Go Away?  

Does stress make tinnitus worse; Tinnitus and stress; Stress related tinnitus go away; Can stress cause temporary tinnitus
As you are better able to manage stress, the tinnitus should improve too.

Technically yes, stress-related tinnitus will improve and possibly "go away" to the point where it is no longer noticeable but it might take some work on your part. It will also depend on whether the stress is related to an isolated incident or if you will be continuously exposed to stressors.

Continued or pervasive exposure to stressors can lead to post-traumatic stress disorder (PTSD). Repeat exposure to stressors can cause additional negative conditioning as you learn to negatively respond to stressors.

There seems to be an association between tinnitus and PTSD: tinnitus severity, abrupt onset of tinnitus, sound tolerance issues, and sound as a trigger for tinnitus are more common in veterans with tinnitus and concomitant PTSD than in veterans with only tinnitus.

Conversely, learning how to reframe stressors may help you to see them as neutral and not to respond to them or to develop positive coping techniques. When you learn to avoid or manage stressors, you may notice significant signs that tinnitus is going away.

Oto Offers Treatment

Take back control of your emotional wellbeing by using the Oto app which offers a comprehensive package of resources for tinnitus that may also improve stress management:

  • CBT
  • Guided imagery
  • Breathing exercises
  • Sound therapy
Tinnitus relief made simple with the Oto app digital therapy programme. Download today.

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