Fibromyalgia and Tinnitus: Navigating the Complex Relationship

woman in pain from fibromyalgia

Fibromyalgia is a non-inflammatory, chronic disorder that causes pain and tenderness throughout the body, as well as fatigue and trouble sleeping. The precise incidence of fibromyalgia is not known, as the condition often goes undiagnosed, or is mistaken for other disorders. Though professionals still do not fully understand the underlying cause there are possible ideations of physical trauma, nervous system dysfunction, and autoimmunity. Many fibromyalgia patients have a heightened sensitivity to pain and the condition can be extremely debilitating. Studies have also demonstrated a much higher rate of diagnosis in females when compared to males. A similarly puzzling condition known as tinnitus often accompanies fibromyalgia, though this particular condition affects the ear and causes ongoing ringing or buzzing, and may involve hearing loss. What exactly are these conditions, and what is at their root?

Genetic And Environmental Influence: Fibromyalgia And Tinnitus

Research suggests that genetics can play a role in fibromyalgia, though the disorder is often triggered by an event that causes physical or emotional stress. Physical trauma, such as a car accident, can be one trigger for fibromyalgia patients’ onset of symptoms. Stress on the body can be another catalyst. Emotional challenges, such as those that might arise following a surgery, a huge life change, experiencing war, or experiencing chronic illness.

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Genetics may also play a role in the development of tinnitus. The underlying cause of tinnitus is known in some cases and remains a mystery in others. The symptoms of tinnitus can arise in response to another condition entirely, or they may arise on their own, without being linked to any additional disorders or conditions.

The presence of one condition can increase the likelihood of developing the other. Stress on the body can lead fibromyalgia patients to experience an exacerbation in tinnitus symptoms, including fullness of the ear, ringing, and even loss of hearing.

Audiovestibular Dysfunction In Patients with Fibromyalgia Syndrome

woman grabbing her ear in pain

Audiovestibular dysfunction, or dysfunction relating to both the auditory system and the vestibular system (hearing and balance, respectively) is one of the many symptoms associated with fibromyalgia. Present findings that support the presence of audiovestibular dysfunction in fibromyalgia patients indicate that individuals with physical trauma leading to fibromyalgia may experience difficulty hearing or maintaining a sense of balance due to abnormalities within the hearing and vestibular organs of the inner ear. Study outcomes suggest that these patients most often present as individuals with elevated hearing levels, middle ear fullness, tinnitus, and general difficulty with auditory signals. 

Additional studies determined that even more abnormal findings were found during audiological evaluations for fibromyalgia patients when compared to patients without the diagnosis. These deficits to auditory and vestibular systems can result in significant impacts to day-to-day living, including the perception of noise, an awareness of one’s own body in space, and a sense of equilibrium and balance.

Central Sensitization And Fibromyalgia

Central sensitization describes a response to pain that is heightened far above what one might consider normal or typical. Central sensitization can make even a small touch or gesture feel painful, and is best identified as a high pain response to a seemingly innocuous feeling. The connection between central sensitization and fibromyalgia, like the syndrome itself, is not fully understood. One theory is that individuals with fibromyalgia have developed changes in the portion of the brain responsible for central nervous system communication–and, in particular, the way pain messages are carried and delivered in the body.

Tinnitus, too, has been linked to central sensitization. Though many do not necessarily equate the noise associated with tinnitus to pain, for others, it can cause a sensation of pain or considerable discomfort. The constant ringing or buzzing can lead to pain of a different type: increased symptoms of anxiety and depression.

Additionally, some studies have proposed that the central nervous system (CNS) plays a significant role in the onset of tinnitus. Coined the “neurophysiological” model of tinnitus, it is believed that damage to the peripheral organ acts as a tinnitus trigger. Once this injury occurs, symptoms are further increased by a domino effect of events in the central auditory pathway in the brain. To determine if this is the root of an individual’s tinnitus, a hearing test can be administered and evaluate the state of the peripheral organ for any abnormal findings.

Why Do Patients With Fibromyalgia Complain Of Ear-Related Symptoms?

The perception of noise may not initially seem to be directly related to fibromyalgia, but there are countless symptoms present in the syndrome, and auditory and vestibular changes are among those symptoms. Despite consistent links between the two conditions, the precise pathogenesis of the connection is still not certain. Underlying causes of both conditions remain, in some ways, mysterious, but fibromyalgia often presents with ear related symptoms such as a sensation of fullness, earache, and tinnitus. These symptoms are often not associated with any abnormal findings, but are instead considered a presentation of central desensitization.

How Tinnitus Interacts With Fibromyalgia

man getting out of bed

When fibromyalgia patients presented with severe tinnitus, they also had more functional impairments and experienced a lower quality of life when compared to patients with only mild tinnitus. The same was true of fibromyalgia patients who experienced insomnia. The two are frequently related; when a feeling of fullness and a phantom sound are constantly present, it can be difficult to manage sleep issues, and many people experience a compromised degree of sleep.

Because fibromyalgia presents with so many different symptoms, some of which patients may not even be fully aware, treatment for the condition typically involves a multidisciplinary approach, with multidisciplinary management techniques. These may or may not include the following:

  • Non-drug interventions. Physical therapy can help reduce some of the symptoms suffered by patients. These therapies can help stretch or strengthen muscles.
  • Active rehabilitation. Active rehabilitation looks different for everyone, but frequently means increasing exercise levels gradually to ensure no additional pain is felt, and taking great care to ease into any new regimens or practices.
  • Pharmaceutical intervention. Some medications such as amitriptyline, duloxetine, milnacipran, and pregabalin have proven useful for patients. Not all patients will experience relief using these medications, but some will see an increase in relief.
    • Note that some patients will experience ear related symptoms in response to these medications, which can further cause or suppress tinnitus symptoms.
  • Mental health management. Many tinnitus and fibromyalgia patients experience psychological distress as a result of their symptoms. Targeting that distress directly can also help soothe some of the difficulties that arise following a diagnosis.

Treatment Of Subjective Tinnitus

Although the focus is often on treating fibromyalgia itself, symptoms can be lessened by addressing some of the co-morbid conditions that are associated with the syndrome. One study found that amitriptyline therapy was an effective treatment for subjective tinnitus. Tinnitus treatment is often highly individualized, but tinnitus severity and other ear-related symptoms were said to decrease when amitriptyline was administered.

Fibromyalgia Treatment: How Treatment Affects Tinnitus

There are four drugs that have been used to treat fibromyalgia, whose activity has been evaluated for use in tinnitus treatment. Of those four drugs, one study found that two instigated significantly decreased symptoms of tinnitus during use. Although this particular study was not conclusive enough to warrant use of these interventions as a frontline treatment for tinnitus, they showed promise and encouraged further investigation into potential pharmaceutical interventions for tinnitus treatment.


Tinnitus and other ear related symptoms are frequently found in fibromyalgia patients. The high commonality between the two conditions suggests that the links between the two warrant further investigation. Because fibromyalgia is often accompanied by a host of different symptoms, triggers, and impacts, treatment is usually highly individualized. Frequent treatment options seek to manage symptoms rather than cure; after all, the precise underlying cause of the syndrome remains unknown. Both fibromyalgia and tinnitus are thought to be conditions of the central nervous system, and other causes of the conditions are continually being evaluated.

Despite the murky understanding of disorder or syndrome onset, there are plenty of therapies and interventions designed to target both conditions, many of them utilizing a multidisciplinary approach that takes the health of the body and mind both into account, in order to treat the disorder or syndrome with as great a proverbial army as possible. By addressing sleep, mental health, activity, diet, and physical trauma, symptoms of both may be diminished, and people with fibromyalgia may be able to better hear, function day to day and undertake physical challenges.

Researchers continue to seek out ways to treat the many physical and emotional effects of tinnitus and of fibromyalgia. By addressing both, people may be able to experience decreases in the severity of both, and experience a substantial increase in their quality of life.

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