Why Tinnitus Gets Louder When You’re Stressed: What the Brain Science Says

Some people with tinnitus hardly notice it. Others cannot focus, sleep or relax. Very often the sound itself is not that different between them. What differs is how the brain, and the body’s stress system, respond to it.

Understanding that response is the starting point for feeling better, because unlike the sound itself, the response can change.

When the brain treats tinnitus like a threat

Your brain is constantly deciding which sounds matter. Most background noise gets filtered out before you are aware of it. But when the brain starts treating tinnitus as a threat, the parts of the brain involved in emotion and alertness get involved.

The amygdala, a part of the brain involved in emotional processing, can increase your awareness of the sound and make it feel louder and more distressing. The more alarming the sound feels, the more attention the brain gives it, and the more noticeable it becomes. That is the loop many people with bothersome tinnitus find themselves in.

What the research shows

Brain imaging studies support this picture. Tinnitus distress has been closely linked to overactivity in the brain’s limbic system, which handles emotion and stress (Leaver et al., 2012; Vanneste et al., 2018). People with chronic, bothersome tinnitus also show stronger connections between the hearing part of the brain (the auditory cortex) and the amygdala (Husch et al., 2020).

In plain terms: for people who are bothered by tinnitus, the sound is wired more tightly to the brain’s alarm system. That is why stress, worry and poor sleep can make the same sound feel so much worse.

Stress, sleep and tinnitus feed each other

The brain focuses on tinnitus more when you are anxious, tired or burned out. Tinnitus, in turn, can make it harder to fall asleep and harder to switch off during the day. Chronic stress and poor-quality sleep can also contribute to tinnitus becoming bothersome in the first place.

Breaking that cycle at any point helps. Calming the stress response, sleeping better or reducing how much attention the sound gets can each make tinnitus less noticeable and less upsetting.

Tinnitus by the numbers

• More than 50 million Americans experience tinnitus (American Tinnitus Association).
• About 20% of people with tinnitus find it truly bothersome, and about 4% find it debilitating enough to interfere significantly with daily life.
• 48 to 60% of veterans returning from combat zones report tinnitus or hearing loss, making it the most common service-connected disability in the VA system (US Department of Veterans Affairs).
• About 90% of people with tinnitus also have some degree of hearing loss, sometimes so mild they have not noticed it.
• People with tinnitus are more than twice as likely to report moderate to severe depression, anxiety or sleep problems (JAMA Otolaryngology).
• Tinnitus is more common in older adults, but it can affect anyone, including children.

What helps: retraining the response

Because so much of tinnitus distress comes from the brain’s response, treatment focuses on changing that response so the sound becomes less important to your brain. Depending on the person, that can include:

• Treating hearing loss with hearing aids, so the brain has more of the outside world to listen to
• Sound therapy, including programs such as Oto that pair sound with exercises drawing on cognitive behavioral therapy (CBT) techniques
• Coping strategies, sleep habits and mindfulness practices such as 4-7-8 breathing
• Referral to a mental health provider when anxiety or low mood are part of the picture
• Lenire, a device that pairs sound with gentle tongue stimulation to encourage the brain to adapt

The dementia question

One worry we hear often is that tinnitus will cause dementia. There is no data to support this.

There is research, much of it from Dr. Frank Lin’s lab at Johns Hopkins, linking hearing loss with a higher risk of dementia from any cause. Hearing loss is one of many modifiable risk factors for dementia, but it is not a cause of it. Treating hearing loss with carefully fitted hearing aids may modestly slow cognitive decline for some people who are at higher risk.

So it is not accurate to say that tinnitus causes dementia, that hearing loss causes dementia, or that treating hearing loss will prevent or cure it. It is a good reason to have your hearing checked carefully, which is part of every tinnitus evaluation.

When to get checked

If tinnitus is affecting your sleep, focus or mood, or has lasted more than a few weeks, a tinnitus evaluation with a Doctor of Audiology is a good next step. See a medical doctor promptly for sudden hearing loss, tinnitus that pulses with your heartbeat, tinnitus in one ear only, significant ear pain or drainage, or vertigo.

If tinnitus is leaving you feeling hopeless or having thoughts of self-harm, help is available any time: call or text 988, or text HELLO to 741741.

Related at Sounds of Life

• Tinnitus Treatment in Concord Township
• Oto At-Home Tinnitus Program
• Northeast Ohio Tinnitus Support Group