The Silent Battle: How PTSD and Tinnitus Are Linked

When you think of PTSD, you may not initially think of auditory changes; when thinking of ringing ears, you may not immediately leap to trauma or a mental health condition. Nevertheless, there are ways the two conditions interact, and facets of the conditions are similar in their origin and management. Before we discuss the particulars of how tinnitus patients and PTSD patients may be similar, we must first take a closer look at what exactly PTSD is.

What Is Post Traumatic Stress Disorder?

The National Institute of Mental Health defines Post Traumatic Stress Disorder (PTSD) as “a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.”

Humans’ brains are designed to keep us alive. There are specific ways that our brain can alert us when we are threatened, allowing us to quickly remove ourselves from a dangerous situation or traumatic experience. One reaction that we experience is often referred to as our “fight or flight” response. When we experience this reaction to something that is potentially dangerous, our bodies prepare us to physically take action. These physiological changes include responses, such as increased heart rate and breathing rate, tunnel vision, and muscular changes.

When a person experiences a shocking, scary, or dangerous event and their body responds accordingly, these physiological changes are normal. After the threat is removed, however, the person’s body is meant to return to their natural baseline. This means heart and breathing rates should slow down, muscles should relax, intense physical stressors should dissipate, and you should “come down” from the experiences unique to an activated sympathetic nervous system.

Many people do recover from these responses naturally. However, some people have difficulty coping and do not experience the expected relief that should come after danger has passed. People who experience continued heightened nervous system indicators even after they are no longer in danger may receive a PTSD diagnosis from a health professional (likely a mental health provider). These people may display exaggerated startle responses and experience constant states of tension and alertness when they are exposed to something that may trigger PTSD-related anxiety.

Who Has PTSD?

Although we are all likely to experience at least one event in our life that can be considered traumatic, not everyone who experiences trauma will develop posttraumatic stress disorder. The National Center for PTSD indicates that about 6% of the U.S. population will have PTSD at some point in their lives.

Research also indicates that women are more likely to develop PTSD than men and veterans are more likely to have PTSD than civilians. Recent research suggests that veterans with a more severe tinnitus handicap score demonstrated significantly greater PTSD traits than those with less bothersome tinnitus.

PTSD was once considered a disorder largely seen in war veterans and others who had been exposed to extreme danger or violence, but as more research about the disorder is conducted, it has grown increasingly clear that a PTSD diagnosis does not require war-time experience.The disorder is now more common among people of all ages and backgrounds than was previously thought.

PTSD Symptoms

The symptoms of PTSD have been identified in part above, but there is a more robust list of symptoms that is necessary to receive a true diagnosis. To receive a diagnosis, the following symptoms must be present for at least two consecutive weeks:

• Intrusive thoughts. Intrusive thoughts can be directly related to the start of PTSD (think uncontrollable thoughts that explore potential consequences related to the event itself), or can be seemingly unrelated, such as being afraid to drive in a car after having witnessed a plane crash.
• Avoidant behavior. The diagnostic and statistical manual requires that avoidant behavior be observed for PTSD to be present, as this is a key source of harm and frustration in patients. People with the disorder often avoid any situations, places, or even thought processes that remind them of the initial trigger for their PTSD. One example might be someone who refuses to speak with a relative who was present when they were mugged. Another might be chronically calling out of work following a traumatic experience in the workplace.
• Cognitive and mood changes. PTSD most frequently exemplifies clinical experience in both depressive symptoms and anxiety symptoms. Patient reports usually involve a sudden onset of high anxiety (which may or may not include panic attacks) and high levels of depressive symptomatology, which can present as spikes in anger, a sensation of anhedonia, or difficulty completing simple tasks.
• Hyper-reactivity or hypervigilance. These symptoms can be identified in self assessments, but can even be seen as observable physical manifestations. Hypervigilant patients may report feeling as though they are always on edge, but they may also flinch away from a doctor’s touch during an exam, or have a strong knee-jerk reflex. To make sure the source of trauma does not strike again, the body’s compensation method involves a sensation of perpetually being at the ready.

Tinnitus Symptoms

Like PTSD, tinnitus can be related to trauma. Symptoms of PTSD can affect one ear or both, and can worsen or improve based on external factors, which is one way that PTSD is similar to tinnitus. The most common symptom of tinnitus is ringing in the ears, but there are other auditory indicators often associated with the onset of tinnitus. How does tinnitus influence auditory behaviors? Tinnitus can affect other auditory symptoms, because tinnitus often comes with comorbidities that may or may not include decreases to hearing, hearing loss, and cognitive symptoms that may be related to the start of ringing in the ears.

How Are PTSD and Tinnitus Related?

How exactly does PTSD affect auditory behaviors? When a person is bothered by their tinnitus, they are likely to experience similar physical symptoms (e.g., increased heart rate, tension, and a feeling of fear or panic) in addition to powerful responses in the form of negative emotional reactions to the perception of their tinnitus.

Incidents such as a new tinnitus onset, acoustic trauma, and noise exposure leading to decreased loudness tolerance may result in PTSD onset. Because PTSD has historically been linked to war-time situations and violence, exposure to gunshots can be among the causes of tinnitus, which may be an example of patients who are a part of the PTSD population and tinnitus population simultaneously.

A series of articles focused on the experiences of Cambodian Refugees indicates that tinnitus can exacerbate symptoms of PTSD. This research highlights specific examples of how traumatic experiences can be strongly linked to tinnitus in a person’s mind. Whether tinnitus began as a result of a trauma or was unrelated, the presence of communicative disorders can negatively impact existing PTSD.

Similarly, other research supports strong neural connections between the systems involved in the generation and perception of tinnitus and the systems involved in generating post traumatic stress responses. In this article, Dr. Marc Fagelson provides multiple strategies that may be helpful for audiologists in evaluating and providing treatment to individuals with concurrent tinnitus and PTSD (e.g., specific audiologic evaluation techniques that are less likely to exacerbate sound tolerance problems or trigger fear, strategies related to the programming of hearing aids, and modified versions of tinnitus services that may be particularly helpful). By targeting several neural mechanisms without triggering a further flare in PTSD and tinnitus, patients may experience a greater spike in effective management and mental health.

Additional Ties

Individuals experiencing PTSD may be at risk for mental health disorders, similar to those with tinnitus. This is often tied to the intensity of experienced symptoms, just as tinnitus severity can determine the likelihood of experiencing negative mental changes. In this way, even when the two conditions are not linked, people with the disorders may have similar experiences.

Treating Tinnitus and PTSD

Tinnitus and post traumatic stress both can result in strong physical and psychological sensations. Tinnitus can lead to avoidant behavior and the onset of mood disorder symptoms, while PTSD can also lead to avoidance (most often due to hypervigilance) and the onset of additional emotional or mental health concerns. Tinnitus treatment and PTSD treatment are not usually considered bedfellows, but when both are present, there can be some overlap in addressing symptoms and managing responses. The overlap most often occurs in the following ways:

• Emotional focus. PTSD is treated as its own disorder, but is often accompanied by depression or anxiety. Tinnitus, too, is often accompanied by depression and anxiety–a prevalence comparable to post traumatic stress, but not comparable to the general population. Although it is something of a “chicken or the egg” conundrum with regard to which was present first, both approaches involve an emotional component to successfully find relief from PTSD and tinnitus. Cognitive behavioral techniques is one of the ways to help alter the emotional components of both PTSD and tinnitus.
• Managing stressors. Tinnitus is a hearing issue that affects one or both ears, and stress has the ability to play a role in the onset of hearing loss or ringing in the ears. Suffering from stress, although it is not the cause of trauma, can negatively contribute to the effects of trauma. By managing stressors, both PTSD symptoms and tinnitus can be addressed. Learning to manage stress in a healthy way through things like meditation or exercise can help improve the way your body and mind react to stressors.

The important takeaway is that there are ways to effectively address and manage both conditions, and experience improved quality of life.