The association between stress, emotional states, and tinnitus: a mini-review

Abstract

Extensive literature supporting the view of tinnitus induced stress in patients is available. However, limited evidence has been produced studying the opposite, that is, does stress cause tinnitus? The hypothalamus pituitary adrenal axis, one of the main neuroendocrine systems involved in stress response, is commonly disturbed in tinnitus patients. Patients with chronic tinnitus have been shown to develop abnormal responses to psycho-social stress, where the hypothalamus pituitary adrenal axis response is weaker and delayed, suggesting chronic stress contributes to the development of chronic tinnitus. The sympathetic branch of the autonomic nervous system also plays a major role in stress response and its chronic hyperactivity seems to be involved in developing tinnitus. Psycho-social stress has been shown to share the same probability of developing tinnitus as occupational noise and contributes to worsening tinnitus. Additionally, exposure to high stress levels and occupational noise doubles the likelihood of developing tinnitus. Interestingly, short-term stress has been shown to protect the cochlea in animals, but chronic stress exposure has negative consequences. Emotional stress also worsens pre-existing tinnitus and is identified as an important indicator of tinnitus severity. Although there is limited body of literature, stress does seem to play a vital role in the development of tinnitus. This review aims to highlight the association between stress, emotional states, and the development of tinnitus while also addressing the neural and hormonal pathways involved.

COVID-19 vaccination-related tinnitus is associated with pre-vaccination metabolic disorders

“…Pre-vaccination psychological health as a risk factor has not been considered in our survey. Stress, anxiety and depression have been associated with risk of tinnitus ( Patil, Alrashid, Eltabbakh and Fredericks, 2023 ). The social distancing-related stress and emotional impact could contribute to the risk of COVID-19 vaccination-related tinnitus.…”

Effect of the COVID-19 Pandemic on Resting-State Brain Activity in Individuals with Tinnitus

“…The COVID-19 pandemic and its requirements for isolation have introduced significant additional stress into the lives of individuals worldwide. Given the established link between tinnitus and stress [36], it is reasonable to expect that there would have been a negative impact on tinnitus sufferers at this time. The potential effect of COVID-19 infection on hearing loss adds another layer of complexity.…”

Tinnitus: Clinical Insights in Its Pathophysiology-A Perspective

“…In the case of misophonia, the common pathway might be the mechanism, which generates the aversive character of specific sounds [ 89 , 90 ], whereas in phonophobia, fear of loud sounds is the common denominator [ 90 ]. Some, but not all, studies [ 91 , 92 ] suggest an increased risk of arterial hypertension among tinnitus patients, which might be an indicator of increased sympathetic activation, which is in keeping with stress as modulating tinnitus [ 46 , 50 , 93 ].…”

“…Imaging studies have shown that tinnitus reduction via distraction is related to reduced neuronal activity in the auditory cortex [ 115 ]. Some patients report that the intensity of tinnitus increases in stressful situations [ 49 , 93 ]. This can be explained by a general enhancement of alertness to sensory signals under sympathetic activation.…”