Why Can Tinnitus Seem Worse When Sick?

Tinnitus is considered a disorder of phantom sound, or a disorder wherein a patient sometimes hears a sound without a definitive reason–though, as you’ll later learn, there are instances in which the “phantom” sound of tinnitus is explained by a medical condition. Tinnitus most frequently presents as a ringing, buzzing, or rushing sound in the ears, and can be acute or chronic, and mild or severe. Because the sinuses and ear canal are closely tied, alterations to one can create changes in the other. The position of the inner ear, middle ear, and sinuses explains what makes tinnitus worse while tinnitus patients are ill, especially when those illnesses involve the respiratory system (think colds or the flu) or the ears, as in ear infections. When these illnesses or syndromes are present, tinnitus symptoms may be exacerbated.

The Connection Between The Ears, The Sinuses, And Everything In Between

Understanding how a simple cold can make tinnitus worse requires a greater understanding of the different parts of the ear, the sinuses, and how inflammation or infection in either can affect tinnitus.

The Sinuses

Each person has four different pairs of sinus cavities, for a total of 8 cavities. Two large frontal sinuses can be found above the eyes (in the forehead), two sphenoid sinuses and two ethmoid sinuses can be found between your eyes and behind your nose, and finally, two maxillary sinuses (the largest of the 8) are positioned beneath the eyes and behind the cheeks.

When tinnitus patients are ill with upper respiratory illnesses like the common cold, influenza, or similar viruses, any of these sinuses can be irritated – leading to inflammation and swelling, and potentially filling with mucus. Inflammation, swelling, and presence of fluid are some of the most significant tinnitus triggers, aside from loud sounds. Unlike loud noises, however, sickness is typically more difficult to avoid and illnesses can be extremely frustrating tinnitus triggers.

The Throat

The pharynx (the throat) can also grow inflamed or swollen when illness is present, which can act as an unexpected way to trigger tinnitus. Throat swelling and inflammation can lead to ear pain and pressure, as the proximity of the middle ear and eustachian tubes to the throat means that an issue in the throat can make tinnitus worse. Throats can become inflamed or swollen with respiratory illnesses, but is also frequently a symptom in infections, such as streptococcus.

The Ears

As we determined above, the throat is related to the ears, and harm to one can make tinnitus worse. That being said, a large portion of tinnitus symptoms come as a result of damage or illness within the ears themselves.

When the sinuses and throat tissues are inflamed, eustachian tubes–the tubes connecting the middle ear to the top of the pharynx, and the avenue by which air travels through the ears–can swell fully or partially closed, and can fill with fluid. This is called Eustachian Tube Dysfunction (ETD), and can make tinnitus worse short-term, and can lead to tinnitus onset in anyone who does not already have tinnitus symptoms.

ETD symptoms frequently include the following:

• Temporary hearing loss
• Aural fullness
• Tinnitus onset
• Popping/cracking sound while swallowing
• Ear pain

ETD can also serve as a catalyst for otitis media (ear infections within the middle ear). Changes in hearing and aural fullness have both been thought to trigger tinnitus, even if it is a temporary condition, which can persist until the eustachian tubes resume normal function.

If tinnitus is already present, inflammation and a reduction in hearing ability can increase existing hearing issues, and worsen tinnitus symptoms until the illness or infection has resolved. An increase in symptoms and further loss of hearing can be extremely stressful for tinnitus sufferers, as tinnitus patients are frequently afraid of making tinnitus worse permanently; fortunately, sickness does not usually lead to permanent tinnitus. Instead, worsening symptoms or sudden onset tinnitus typically only last throughout the course of the illness, and dissipate once the illness or infection has resolved.

Can Certain Medical Interventions Make Tinnitus Worse?

Medications and interventions designed to alleviate symptoms of various illnesses and viruses can actually lead to adverse effects like tinnitus and hearing changes, and both over the counter and prescribed medications have the ability to make tinnitus worse or prompt tinnitus symptoms to appear. In some cases, the medication-onset tinnitus resolves once the course of medication has concluded, though there are bases of ototoxicity that can lead to permanent hearing loss or tinnitus.

Ototoxicity is not extremely common, and tinnitus symptoms are not always linked to medication. Whether it causes permanent hearing loss or permanent hearing changes, or only impairs hearing and sparks tinnitus symptoms in the inner ear temporarily, any concerns you may have about hearing loss and tinnitus can be taken to your doctor, in order to elect for a treatment that does not negatively affect tinnitus symptoms or onset.

The Toll Of Sickness On Physical And Mental Health

Tinnitus triggers can be found in many different things, from loud noises, a sinus infection, or even malfunctioning or poorly functioning blood vessels. These tinnitus triggers can be common, with frequent ties to making ears worse, or they can be more uncommon and occur largely as a result of stress on the body as a whole. Having a cold, influenza, an ear infection, a sinus infection, or any other upper respiratory illness can cause a great deal of stress on the body physically and mentally, both of which can trigger tinnitus.

Physical

Although we have briefly touched on some of the illnesses that can aggravate tinnitus, there are many different conditions and illnesses that can lead to tinnitus symptom development. These include the following:

• Sleep difficulties. Sleeping with a stuffy nose or sore throat can be difficult, and sleep deprivation is known to make tinnitus worse. This is not necessarily because the loud noises associated with tinnitus actually grow worse, but because sleep deprivation or poor quality sleep can make it far more apparent that noises are present. Background noise can help reduce the loud sounds of tinnitus, in order to break the vicious cycle of experiencing sleep dysfunction, seeing a spike in tinnitus symptoms, and experiencing further sleep difficulties.
• Painful ears. When ears are infected or blocked or hearing is reduced, a person with existing tinnitus may become more aware of their ears. When someone is more aware of their ears and any problematic perceptions being taken in by their ears, the negative impacts can compound, and may make their awareness of tinnitus spike. In these cases, noisy environments and background noise may not help, as the issue resides within the ear itself, rather than external sounds.

Mental Health

Although being unable to fall asleep and experiencing hearing damage is difficult enough, tinnitus and the conditions leading up to tinnitus can negatively impact your mental health, as well. Aside from negative thoughts, there are other impacts to mental health. These may include:

• Falling behind. If you are sick for an extended period of time with an illness causing tinnitus, sleep problems, and general malaise, you may find yourself falling behind on responsibilities at school, at work, at home, or in your relationships. Falling behind can lead to stress, which has been shown to increase the awareness and disturbance levels of people with tinnitus.
• Negative thoughts. When we aren’t feeling our best, negative thoughts can quickly and easily creep in. Sickness can cause us to lose out on daily joys and rituals, which can lead to a spike in feelings of sadness, hopelessness, and depression. All of these can increase tinnitus symptoms, as well.
• Sleep problems. While there are plenty of physical issues that lead to sleep problems, mental health can make it difficult to fall asleep, as well, further encouraging a spike in tinnitus. Many patients see a difference in symptoms when they are sleeping well and consistently.

What To Do If Tinnitus Worsens While Sick

First, consider breathing a sigh of relief now that you know illness does not usually result in permanent changes to hearing, and tinnitus may resolve as your illness does. Maintaining a positive attitude can help soothe some of the anxiety and stress that can come about when you hear ringing in your ears. From there, be sure to wear earplugs or another form of protection if you are going to be exposed to cold air or wind, and follow all recommendations for healing provided by your doctor. Prolonging treatment or failing to engage in proper care can further exacerbate tinnitus.

Should you notice any worsening tinnitus symptoms after taking any medications, as many medications can be ototoxic, be sure to consult with your doctor right away, to make sure your daily life is not impacted any more than is necessary.

Treating Tinnitus

Provided that ringing in the ears has already been present, or you are already aware that you have begun to hear phantom sounds, make sure to seek treatment for any hearing loss and tinnitus symptoms you may experience. An ENT or audiologist can conduct a comprehensive exam and hearing test to evaluate the root of your condition, and identify any factors that may be known to worsen tinnitus. They can also evaluate blood vessels and other possible underlying conditions to appropriately treat the symptoms.

If you already have a tinnitus treatment plan in place, or you already use hearing aids, check with your provider or an audiologist to make any necessary adjustments to your hearing aids, and consider utilizing them as a way to deliver sound therapy, which has been shown to improve symptoms.

Tinnitus treatments like sound therapy, cognitive behavioral therapy (CBT), and tinnitus retraining therapy (TRT) are all great, evidence-based treatment options for tinnitus, no matter the starting point of the condition, including constant exposure to loud noise and prolonged infection. Many of these interventions can also be helpful if illness or sickness has sparked a temporary increase in symptoms. Speak with a medical professional or audiologist to break the vicious cycle of increased symptoms and chronic ringing in your ears, sickness and stress, and worsening symptoms and enjoy greater quality of life.