Is It True That Stress and Anxiety Can Cause Tinnitus?

[Jack.aft]

Hi doctor. My name is Jacqueline and I've recently been going through a period of high stress and anxiety and I've been experiencing physical symptoms. My doctors believe that one of these symptoms is tinnitus.

Is it true that stress and anxiety can cause tinnitus?

I went to an ENT and the audiogram showed no hearing loss. He thought I had ETD because I had a cold in February. He also thinks the stress could've tensed my muscles and caused tinnitus. I'm only 18...

Have you seen a lot of cases where tinnitus fades away?

Also if stress and fight or flight caused my tinnitus, once my nervous system calms down do you think my tinnitus can go away? I'm trying not to lose hope.

The tinnitus also fluctuates. Sometimes I feel like it's gone but then sometimes it's back. Why is this? Especially in the morning it's totally gone. Then it starts to come back.

Thanks!

 

[Dr. Nagler]

Hi doctor. My name is Jacqueline and I've recently been going through a period of high stress and anxiety and I've been experiencing physical symptoms. My doctors believe that one of these symptoms is tinnitus. Is it true that stress and anxiety can cause tinnitus?

Hello Jacqueline -

Thank you for your interesting question. I am sorry that it has taken me so long to get around to responding. I have been (and still am) attending to some important family matters. I hope over the next weeks to very slowly catch up with the backlog of questions and will start with yours.

So the short answer to your question is that nobody knows because it is impossible to do the types of controlled studies necessary to arrive at a definitive answer.

That said, however, I can tell you what a number of tinnitus clinicians (including myself) believe to be the case based upon experience. And that experience is that it is rather common for folks who cannot pinpoint an exact cause for their tinnitus to observe that it developed during a time of increased anxiety and stress. As to which came first - the stress or the tinnitus - well, that can be a difficult thing to tease out because intrusive tinnitus will invariably cause stress, and increased stress is bound to make tinnitus sound louder. Your question, however, does not focus on whether or not stress will make tinnitus louder, but rather on whether stress can actually cause tinnitus in a person who had never before experienced tinnitus.

My view (again shared by a number of other tinnitus clinicians) has to do with the fact that the auditory system is one of the most active neurological systems in the body, and as such the normal auditory system does not only detect signals that originate outside the body (like the sounds experienced in everyday life), but it also generates signals of its own, signals that are generally undetected. There are a number of experiments where people who are placed in a totally dark and silent chamber become completely disoriented within a few minutes; they develop terrible vertigo, they start seeing designs and flashing lights "that are not there," and their ears start screaming, all as a result of the total deprivation of sensory input. You can do it yourself (without aggravating your tinnitus) by going into a very dark room and shutting your eyes tightly. Within a few minutes most folks will start "seeing" geometrical designs - circles, lines, diamonds, etc. that obviously "aren't there." What they are seeing is the cortical (conscious) representation of spontaneous activity in their visual system.

Well, as I have come to see it, tinnitus is the sum total of all of the spontaneous activity in the auditory system. For most folks the spontaneous activity represents a "code for silence." I realize that what I am about to say may be unpopular (or at the very least controversial), but the presence of some degree of tinnitus is normal. Everybody has spontaneous activity in their auditory systems - so everybody has some degree of tinnitus. It's just that for most folks their tinnitus is not audible (unless, for instance, they participate in one of the experiments to which I referred in the paragraph above). So what can turn tinnitus that is not audible into tinnitus that is audible? One way would be to change the pattern of spontaneous activity, which is what happens with noise-induced auditory damage, ototoxic medications, etc. And another way would be if the pattern of spontaneous activity that used to code for silence ceases to do so, which is what I suspect happens in stress-induced tinnitus. In other words, stress does not cause tinnitus, but rather stress causes tinnitus to emerge - sort of like uncovering it. And once that tinnitus has emerged (i.e., once it has become apparent), it is very difficult to cover it up again because tinnitus emergence is itself stressful! Elsewhere I have discussed the role of the autonomic nervous system in this process (see "Message Number Three" in the attached article). And that is the mechanism whereby I suspect that stress can "cause" tinnitus - by interrupting the code for silence.

Now I readily admit that I could be totally wrong in what I have written above. It is pure conjecture based upon observation and a little understanding of neurophysiology.

Hope this helps.

Stephen M. Nagler, M.D.