Tinnitus And Anxiety Disorders: Is There A Connection?

Tinnitus is a condition wherein the perception of sound occurs in the absence of an external auditory stimulus. While this may seem unusual, tinnitus actually affects approximately 10-25% of the population of the United States. The intensity of tinnitus symptoms can differ widely among individuals—some find it severely disruptive to their daily activities, while others experience only mild, occasional symptoms. Moreover, severe tinnitus can manifest symptoms similar to those of anxiety disorders, and it has been linked to psychological issues such as anxiety, depression, and other forms of emotional distress.

What Do The Terms Anxiety And Depression Mean?

While the terms “depression” and “sadness” are frequently used interchangeably, it is important to distinguish between the two. Clinically, depression refers to a persistent state of low mood or unhappiness that endures for a minimum of two weeks and adversely affects one’s daily functioning. Contrary to popular belief that suggests its rarity, current data indicates that approximately one in six adults will encounter symptoms of depression at some point in their lives. To distinguish the differences between depression and transient sadness, the primary symptoms of depression include:

• Feeling sad or anxious often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable‚ easily frustrated‚ or restless
• Having trouble falling asleep or staying asleep
• Waking up too early or sleeping too much
• Changes in eating habits and/or appetite
• Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
• Having trouble concentrating, remembering details, or making decisions
• Feeling tired‚ even after sleeping well
• Feeling guilty, worthless, or helpless
• Thinking about suicide or hurting yourself

To date, the underlying causes of depression remain somewhat elusive. Although it is unclear why certain individuals develop depression and others do not, several risk factors have been identified that may elevate the likelihood of manifesting depressive disorders. These factors encompass:

• Having a family history of depression
• Experiencing traumatic or stressful events, such as abuse, the death of a loved one, or persistent financial problems
• Going through a major life change‚ even if it was planned
• Having a medical problem, such as cancer, stroke, or chronic pain
• Taking certain medications
• Using alcohol or drugs

It’s not rare for people diagnosed with depression to also struggle with an anxiety disorder. Often, symptoms of anxiety and depression overlap, making it challenging to distinguish between the two.

So, what is anxiety, really?

Many people mistake anxiety for stress, but they are not the same thing. While stress is a natural reaction to specific events or situations, anxiety is a mental health condition that may arise in response to stressors related to tinnitus.

Anxiety describes the state in which an individual struggles with intense and uncontrollable feelings of anxiety, fear, worry, or panic. Anxiety disorders are currently considered the most common mental disorder diagnosed, and they affect almost 30% of adults at some point in their lives. There are different types of anxiety, each of them with their own unique set of symptoms. Disorders include: generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (with or without agoraphobia), phobias, agoraphobia, separation anxiety, and selective mutism. Anxiety symptoms include the following:

• Feeling nervous, restless or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating
• Trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling worry

Anxiety and depression may be common, but even a mild anxiety disorder can have negative effects elsewhere in a patient’s life, including issues within the inner ear, and flare-ups in tinnitus symptoms.

What Is Tinnitus?

While tinnitus symptoms may seem to be fairly straightforward, there is more than one type of tinnitus, and each type can affect the auditory system in different ways. The most common categories used to identify tinnitus include subjective, neurological, somatic, and objective tinnitus. All possess the core symptoms of tinnitus–disruptions to the auditory system, characterized by phantom noises such as whooshing, ringing, buzzing, or hissing–but have different roots and different methods of treatment.

Subjective Tinnitus

Subjective tinnitus is the most common type, and has symptoms that are only audible to the patient. Most cases of subjective tinnitus are the result of damage to the auditory system, including hearing loss of the inner ear (typically presbycusis or noise-induced hearing impairment). Subjective tinnitus cannot be measured by a test, but is instead evaluated using testing or questionnaires that rely on subjective feedback from the tinnitus patient.

Neurological Tinnitus

A far less common form of hearing impairment, neurological tinnitus is specifically associated with changes in hearing that come about as a result of changes or damages to the brain as it relates to auditory function. Tinnitus perception in these cases is not terribly different, but the root cause is significantly different.

Somatic Tinnitus

This is a type of subjective tinnitus, in which the frequency or intensity of tinnitus symptoms are altered by various body movements, such as clenching the jaw, turning the eyes, or applying pressure to the head and neck. Treatment often focuses on relieving muscle tension in or around these areas to help alleviate tinnitus symptoms.

Objective Tinnitus

Objective tinnitus is a type of tinnitus that does not necessarily respond to behavioral therapies, because the root cause is more likely to be a medical one. This form of tinnitus is audible to another person as a sound actually emanating from the ear canal, and there may be a medical treatment option for these cases. Pulsatile tinnitus is one type of objective tinnitus, wherein a rhythmic sound is heard in the ear, in conjunction with blood vessels near your ears. It often matches heart rate, and may sound more like rushing or roaring. Objective tinnitus is nearly always persistent tinnitus, and patients affected may be able to experience relief following medical intervention.

Relationships Between Tinnitus, Anxiety, And Depression

Data regarding tinnitus symptoms and severity and how they relate to anxiety and depression symptoms was taken from a 2007 health review, which touched on responses from adults regarding anxiety disorders, depression, tinnitus, and how the three may interact. The severity of anxiety and depression have been correlated with tinnitus severity. When tinnitus severity is reported as high, the individual in question is more likely to also report symptoms of anxiety and depression. The reasons can be wide and varied; tinnitus sufferers report significantly fewer mean (average) hours of sleep per night, and greater mean days of missed work, when compared to people without tinnitus symptoms or a tinnitus diagnosis. Both of these, alone, can contribute to increased depression and anxiety symptoms.

Other works have shed light on the different relationships between tinnitus symptoms and mood disorders like anxiety and depression. One report suggested a 78% lifetime and 60% current prevalence of major depression among tinnitus patients, which showed a significantly higher prevalence for major depression than populations without tinnitus. Another found that tinnitus patients also showed more significant anxiety inventory and depression inventory scores than populations without tinnitus sufferers. All of this research suggests that the psychological distress within tinnitus is very real.

Home Remedies For Anxiety

Most people with anxiety disorders are best served by enlisting the help of psychotherapy or medications in order to manage symptoms and get their anxiety under control. That being said, however, lifestyle changes can help make a difference for people with anxiety. Some of the most commonly suggested interventions and lifestyle remedies include:

• Exercise/physical activity, like aerobic exercise
• Avoiding alcohol and other drugs
• Avoiding or quitting smoking
• Quitting or cutting back on caffeine
• Stress management, like meditation and relaxation techniques
• Getting enough sleep
• Eating a healthy diet
• Alternative medicine/herbal remedies
• Deep breathing exercises and yoga
• Journaling
• Cannabidiol (CBD), if available where you live
• Aromatherapy

Although none of these are intended to take the place of professional help, they can help support a healthy mental state.

Home Remedies For Tinnitus

There are many ways to support your hearing health and address tinnitus from home. The most common recommendations include:

• Sound therapy (white noise machine, sound generators, or hearing aids for hearing impairment)
• Hearing protection
• Avoiding loud volumes (headphones, loud music, etc.)
• Limiting alcohol, caffeine, and nicotine
• Alternative medicine (acupuncture, melatonin, ginkgo biloba, and zinc supplements)
• Tinnitus support groups and education
• Dedicated stress management

As with anxiety, none of these lifestyle remedies are intended to be done in isolation, or without the help of a qualified provider. Instead, these remedies–some of which are frequently used by hearing professionals to help tinnitus sufferers–are to be used as a supplemental program that works in conjunction with a dedicated tinnitus treatment plan.

The Hearing Loss Factor

Although hearing loss is known to be a factor affecting tinnitus prevalence, one study found that hearing loss did not significantly affect the relationship between tinnitus and depression, anxiety, and somatic symptom disorders. This means that both anxiety and depressive symptoms possess a significant relationship to tinnitus onset.

Can Anxiety Cause Tinnitus?

The precise relationship between tinnitus and a psychiatric disorder like anxiety remains unclear to researchers. It is thought, however, that the nervous system can play a role in the onset of tinnitus in those with anxiety and depressive symptoms; different psychiatric disorders activate the sympathetic nervous system (often referred to as the “fight or flight” system). When activated, the body experiences increases to blood flow, increases in body heat, racing heart, and even shallow breathing. All of these can impact the inner ear and trigger the onset of tinnitus symptoms. Whether otologic symptoms like dizziness and tinnitus are associated with emotional stress is still being evaluated, it is thought that anxiety can trigger tinnitus, making it important to address both anxiety and tinnitus from the perspective of reducing stress and supporting a healthy nervous system.

Further Support For Psychiatric Comorbidities With Tinnitus

Mental health was shown to have a significant association with tinnitus; one study evaluated the presence of different psychiatric symptoms and anxiety in patients with chronic tinnitus. This is significant, whether patients have normal hearing or also experience hearing loss, as clinical implications can help more effectively inform appropriate tinnitus and mental health treatment. Study participants showed increased psychiatric comorbidities than those without tinnitus, suggesting that mental health intervention should be addressed alongside tinnitus.

Another study looked at the prevalence of depression, anxiety, and somatic disorders among patients with tinnitus. A statistical analysis demonstrated that depressive mood and anxiety symptoms were more likely to be found among individuals experiencing tinnitus than the general population without a tinnitus problem. Although the evaluations were completed using a self-administered questionnaire rather than a clinical evaluation of mental health symptoms, there remains a relationship between decreases in mental health, quality of life, and tinnitus, even if the exact causal relationship remains unclear.

Mental Health And Tinnitus

Chronic tinnitus does far more than affect hearing. Tinnitus patients are far more likely than those who do not develop tinnitus to experience decreases in quality of life and increases in mental health symptoms. Whether hearing loss is or is not present among tinnitus patients is immaterial; there remains a positive correlation between tinnitus and mental health disorders like anxiety and depression. Whether medical treatment, mental health treatment, or treatments to address hearing impairment are utilized, patients with tinnitus may experience improvements to anxiety and depression severity when their tinnitus is addressed, and people with tinnitus may experience improvements to their tinnitus symptoms when mental health is addressed.