Tinnitus And Stress: What You Need To Know

Do you have ringing in your ears or suffer from tinnitus? If so, you’ve probably looked for ways to ease or relieve the sensation to improve your quality of life. This article aims to present ways to help you with your tinnitus by focusing on psychological stress and how it impacts tinnitus.

The Psychological Response To Tinnitus

Tinnitus is believed to originate from the auditory system, often associated with a hearing loss or other objective auditory symptoms. However, the perception of tinnitus is complex and influenced by other areas of the brain, such as those that modulate emotional responses.

After working with tinnitus patients for years in the in-person and telehealth model, I’ve seen that reducing the negative psychological response to tinnitus can improve the treatment outcome. We can do this by essentially “rewiring” certain areas of our brain that produce these responses within the limbic system.

The limbic system is an area of the brain that processes emotional responses, i.e. the brain’s “emotional center.”  When tinnitus occurs, originating in the auditory system, it can cause an emotional response – for some people this may be a feeling of stress or anxiety. If we can “rewire” our brain to alter our response to the tinnitus by reducing negative emotions associated with the tinnitus, this in turn can help improve the tinnitus perception!

This rewiring takes time. Working with a therapist or an audiologist or learning the facts about tinnitus can make all the difference in reducing stress or anxiety related to it. Learning about tinnitus helps to explain the fight, flight or freeze response. It will also show you how understanding it can change the outcome of your tinnitus– and the course of your life.

Understanding The Stress Response And Tinnitus

So how does the stress response impact tinnitus? The neurophysiological model of tinnitus is useful in deciphering the relationship. The better we understand how tinnitus can create a stress response, the better we can understand how to reduce that response.

According to this model, there are both auditory (i.e. the inner ear), as well as non-auditory systems (i.e. the limbic system) at play in the perception of tinnitus. While the signal is likely generated from somewhere within the auditory pathways, the emotional response is modulated by other systems within the brain. This is key to understanding why tinnitus is more bothersome to some individuals than others. Although the sound of tinnitus (i.e. the ringing or buzzing) is not in itself a “threat,” when the brain reacts like it is, it can cause a stress response. This is not necessarily a conscious decision – rather, it is a response modulated by the limbic system.

Another consideration is that sometimes tinnitus comes first, and anxiety and stress come second. Other times, anxiety and stress were already there and perhaps tinnitus is exacerbated as a result. In any case, having bothersome tinnitus that affects you most of the day may create a high degree of stress and anxiety and create a vicious cycle.

The limbic system is the area in the brain where we translate and process how things emotionally affect us through our sensory information. It processes the information to tell us what to focus on in our conscious waking state. If we can alter the way we process tinnitus, then we can reduce the impact.

How To Work With Our Brain

There are many ways to “hack” our limbic system. This may involve working with a well-trained audiologist and/or therapist to help with stress or anxiety. Additionally, meditation or other relaxation measures to help calm the mind and relax the body can help your tinnitus response. Feeling calm will show the brain and body, “Hey, this signal of tinnitus, this constant sound, I’m not threatened by it.” The fact is that tinnitus is a mild body sensation, not a harmful, life-threatening condition. Remembering this can be helpful to help reduce the perception of tinnitus.

While the tinnitus signal itself is often generated from the inner ear or other related parts of the auditory pathway, the emotional response modulated by the limbic system what drives the reaction to the tinnitus (i.e. how bothersome it is). This is why people often report that stress or anxiety can cause the tinnitus to “spike” and feel less bothersome during times of less stress.

Understanding that your tinnitus is not only an auditory condition, but has involvement with other areas of the brain is important in treatment.

What To Do When Hearing Loss and Tinnitus Occur Together

The first step is to have a full audiological evaluation to determine the severity and type of hearing loss by an audiologist. If there are any accompanying medical issues, such as dizziness, sudden onset of symptoms, ear pain, etc. a full medical examination should be performed by a physician with appropriate treatment, if applicable.

In cases where there is hearing loss with tinnitus that requires management by an audiologist, hearing aids can often be helpful. For many individuals, properly fit hearing aids can greatly reduce the impact of tinnitus in their daily lives. For other individuals with more severe tinnitus, other intervention such as sound therapy or tinnitus retraining therapy can be helpful. 

Next Steps

I think the best way to do this is to use sound therapy or to have one-on-one counseling with someone who is well-trained and has personal experience with tinnitus. Our audiologists fall into that camp. We’ve seen that the one-on-one model, whether meeting weekly, biweekly, or monthly, is effective in getting out of these negative thinking loops. 

In one-on-one counseling, our job, and your job is to help you condition your brain to change how it categorizes tinnitus. So when you work to eliminate the stress response over time, the debilitating effects of tinnitus subside, and habituation begins to occur. 

Some patients have extreme involvement of the limbic system. When that happens, medication or higher forms of intensive counseling like psychiatry or psychology intervention is helpful. All of those are used in unison with tinnitus sound therapy. The best approach is to take a comprehensive view of the limbic system activity along with complimentary tinnitus sound therapy with the assistance of a Treble Health audiologist. 

In our experience, therapy with a Treble Health tinnitus specialist in the telehealth online video consultation modality has been an effective treatment and therapy for tinnitus. Including tinnitus sound therapy or hearing aids, gets people through the most challenging parts of tinnitus and allows them to habituate. Once habituated, you don’t need one-on-one counseling, and you don’t need individualized tinnitus masking set up for your ears. Instead, you can phase those out over time. 

For those who are going through severe levels of distress, an audiologist on our team may need to refer you to our telehealth partners for therapy, mental health therapy, and psychiatry. It may be appropriate to consider medication, given the degree of distress. We can connect you to the right professional to ensure we’re doing everything possible to keep the limbic system in check to help you with your habituation. 

Scientific citation for this article partially comes from:

Jastreboff PJ, Gray WC, Gold SL. Neurophysiological approach to tinnitus patients. Am J Otol. 1996 Mar;17(2):236-40. PMID: 8723954.