Tinnitus: The Sound of Stress?

[hans01]

Full article:

https://clinical-practice-and-epidemiology-in-mental-health.com/VOLUME/14/PAGE/264/FULLTEXT/

Not sure if this has already been posted before. It has been published on 31/10/2018.

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ABSTRACT

Background:
Emotional stress is frequently associated with otologic symptoms as tinnitus and dizziness. Stress can contribute to the beginning or worsening of tinnitus.

Objective:
The objective of the study is to evaluate the presence of stress symptoms in patients with chronic, subjective tinnitus, and correlate its presence to annoyance associated with tinnitus.

Methods:
This is a cross-sectional study. One hundred and eighty patients with chronic, subjective tinnitus were included. Patients answered the Tinnitus Handicap Inventory (THI) to evaluate the impact of tinnitus in the quality of life and answered the Lipp's inventory symptoms of stress for adults (ISSL). The data obtained was organized using Excel® 2010, mean values, linear regression and p-value were calculated.

Results:
Of the 180 patients included in the study, 117 (65%) had stress symptoms, 52 of the 117 (44%) were in the resistance phase and 23 of the 117 (20%) in the exhaustion phase, the remaining was in the alert phase. There was a clear progressive increase in stress as THI raised, with more impact of tinnitus in quality of life.

Conclusion:
The presence of stress symptoms, measured by ISSL was observed in most of our patients with chronic subjective tinnitus, specially in the resistance and exhaustion phases and it is directly associated with tinnitus annoyance.
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For me, even if I have to admit that the onset of my tinnitus 20 years ago is still unclear (playing music, sinus infections, emotional stress...), it started during a very stressful period (which I'm still in as a freelance worker) and got worse when I had a burnout 3 years ago with some additional very low tones, so I'm sure there must be a link. In some days late in the afternoon especially just before the weekend or when I'm feeling very relaxed my tinnitus drops significantly in volume, so there must be a link, it's not 100% related to my bad hearing.

 

[Strife_84]

My tinnitus or hyperacusis has nothing to do with my mental state.

When I am tired I get annoyed by my tinnitus more easily, but the volume is still same.

Ive been depressed, happy, sad, tired, alert.

Always the same. changes in volumes usually triggered by sounds coming from outside. Sometimes my tinnitus just gets louder while sitting still.

I don't believe it's mental, at all. If stress or anxiety would cause tinnitus, I would've had tinnitus for 20 years now.

 

[hans01]

We're not all the same and I've never said it's "only" stress or anxiety related. Tinnitus can have different causes but in my case and those people I talked to there's definitely a link to stress and anxiety, not just exposure to noise like all ENTs seem to claim. For example mine went down quite a lot this weekend, some tones hardly audible, but then I had a lot of fun with people around me, really relaxing weekend. Sometimes stress related health issues can pop up later on, it's not triggered the first day you have stress. Anyway, I respect your observations but for me it's definitely linked to mental well being, not just sound exposure.

 

[razo]

Mine also varies with stress levels. There must be a connection between cortisol levels and increased exitability of neurons in our tinnitus.
https://www.sciencedaily.com/releases/2008/08/080807072125.htm

 

[hans01]

Mine also varies with stress levels. There must be a connection between cortisol levels and increased exitability of neurons in our tinnitus.
https://www.sciencedaily.com/releases/2008/08/080807072125.htm

Interesting, I have some form of PTSD and my cortisol levels are too high, which isn't good. A friend suggested to do sophrologie, and the more I learn about tinnitus and the harmful effects of stress on life, the more I agree that maybe the problem starts there for a lot of people, not just regarding tinnitus but a bunch of other health related issues.

 

[Autumnly]

The Cortisol Awakening Response: A Feasibility Study Investigating the Use of the Area Under the Curve With Respect to Increase as an Effective Objective Measure of Tinnitus Distress
Funded by the BTA

Purpose
Tinnitus is a chronic medical condition that can result in distress, concentration difficulties, and clinical depression. An effective, objective measure of tinnitus distress does not currently exist. Endocrinal studies into the condition have been few, with those investigating the cortisol awakening response limited in scope. It was hypothesized that distressed individuals with tinnitus would awaken and be unable to effectively prepare for the day ahead due to a blunted cortisol response.

Method
Twenty individuals with varying tinnitus distress were compared with a control group (n = 10) in a pilot study, which measured salivary cortisol concentrations on awakening. Multiple exclusion variables were applied.

Results
In line with previous studies, total cortisol volume (as measured by area under the curve) was not found to be significantly different in the most distressed individuals with tinnitus, F(2, 26) = 0.254, p = .777ns. However, a separate measure of changing cortisol levels—the area under the curve with respect to increase (or AUCi)—was found to be significantly less robust in those individuals reporting the most severe tinnitus distress, F(2, 26) = 7.671, p = .002. This indicates that fewer resources would be available to cope with the demands of the day ahead. Additionally, the AUCicorrelated negatively with tinnitus distress later the same day.

Conclusions
Relationships between proposed objective and self-reported components of self-reported tinnitus distress are considered, with some aspects of tinnitus distress more closely related to physiological mechanisms than others. It is suggested that, with further research, the cortisol awakening response (AUCi) may be put forward as a credible objective biomarker of tinnitus distress.

 

[Starthrower]

with some aspects of tinnitus distress more closely related to physiological mechanisms than others.

What would be considered "physiological mechanisms"?

 

[carolinet617]

We're not all the same and I've never said it's "only" stress or anxiety related. Tinnitus can have different causes but in my case and those people I talked to there's definitely a link to stress and anxiety, not just exposure to noise like all ENTs seem to claim. For example mine went down quite a lot this weekend, some tones hardly audible, but then I had a lot of fun with people around me, really relaxing weekend. Sometimes stress related health issues can pop up later on, it's not triggered the first day you have stress. Anyway, I respect your observations but for me it's definitely linked to mental well being, not just sound exposure.

Interesting! I also have PTSD and my doctor has told me before she suspects my cortisol levels are too high. I'm constantly in fight/flight/freeze mode. I've been keeping track and my T does tend to get quieter at times when my depression/anxiety is at it's lowest or I've had better sleep (which reduces my anxiety which reduces my T!)

And yes, it's really important like you said to point out that everyone's different. Certainly not ALL tinnitus is caused by stress, but it can definitely play a part with some people. I'm new to T but one of the biggest things I'm noticing is how drastically different everyone's story is (how they got it, what works and doesn't work for them etc.)

 

[Gabriel]

I think stress has totally something to do with tinnitus BUT it can't make it appear by its own...
I've had stress but never tinnitus, and if stress was alone triggering tinnitus, probably 100% of population would have it cause honestly we're all stressed at one point in life.
And my tinnitus actually started at the best time of my life, when I finished my study, met a girl, and got my depersonalisation and depression going off. 1 month after boom, tinnitus.

So yeah, more stress might imply louder tinnitus, and less stress could imply lesser tinnitus, BUT tinnitus is not due to stress.

 

[hans01]

I think stress has totally something to do with tinnitus BUT it can't make it appear by its own...

That's really difficult to confirm.

A friend told me and he had tinnitus when he had stressful periods when he was child, and and that time he didn't had any hearing issues and the tinnitus went away when things calmed down for him.
In some moments when stress and especially emotional stress is high for me I have new tinnitus tones that can come in and go away when I do my best to relax so stress can definitely make tinnitus appear in my case.

 

[hans01]

And yes, it's really important like you said to point out that everyone's different. Certainly not ALL tinnitus is caused by stress, but it can definitely play a part with some people. I'm new to T but one of the biggest things I'm noticing is how drastically different everyone's story is (how they got it, what works and doesn't work for them etc.)

Yes indeed we're all different, I can only speak from my own experience and just like you I'm almost constantly in fight/flight mode since I started working as freelancer 19 years ago. If stress can give you other health issues why not T? For me it's more and more clear now that we need to work on stress, sleep and more positive things in life, but that seems not always to be easy.

 

[Frédéric]

Comorbidity of Chronic Tinnitus and Psychological Stress - Which Came First, the Chicken or the Egg?

Subjective tinnitus is a frequent, debilitating hearing disorder causing severe emotional stress and psychological suffering. Likewise, many reports show that the onset of tinnitus occurs at the time of high stress or after a period of stress. It is also common for existing tinnitus to become worse during exposure to stress. However, in clinical practice the association between tinnitus and stress is often neglected. Extensive search of the Web of Science database has shown a low ratio of scientific articles about coexistence of stress and tinnitus compared to other stress-related conditions. Specifically, there are about sixteen times more articles investigating comorbid stress in chronic pain, about six times more in chronic fatigue, and about four times more in fibromyalgia. Previous studies of biological markers of stress in tinnitus patients showed normal diurnal levels of stress hormone cortisol. However, experimental studies of tinnitus subjects showed a blunted reactive cortisol response after a psychosocial stress test, exposure to noise in the laboratory and a dexamethasone suppression test. In addition, tinnitus subjects showed increased sympathetic tone, and weakened sympathetic response after exposure to mental arithmetic task. In tinnitus subjects oxidative metabolism shows imbalance with shift from antioxidant enzyme preponderance towards oxidative stress predominance. Relaxation therapeutic programs reduce stress-sensitive immunological parameter tumor necrosis factor alpha. Although existing data indisputably proves existence of comprehensive connections between tinnitus and psychological stress, there is still no empirical evidence to show whether stress as a etiological, or just contributing factor. Further research should give the ultimate answer on this subject.