PTSD and Tinnitus: Why the Ringing Won't Settle

Most people know tinnitus as ringing in the ears. Far fewer realise how often it travels alongside post-traumatic stress, or how firmly the two hold each other in place. For someone living with PTSD, a sound that others shrug off as a minor nuisance can become a running commentary that something is not right.

Two problems, one alarm system

Tinnitus is the perception of sound that has no outside source. It is common: research summarised by the National Institute on Deafness and Other Communication Disorders puts the figure at roughly 10 to 25 per cent of adults. PTSD is less common, yet the overlap between the two is far larger than chance would suggest.

Part of the reason is straightforward. A single event can cause both. Blast exposure, a serious car crash, an assault, a workplace incident involving machinery: these can injure the auditory system and create psychological trauma in the same instant. In the United States, tinnitus is the most common service-related disability among veterans.

Why the brain keeps the volume turned up

The more interesting part is what happens afterwards. The tinnitus signal may begin in the ear, but whether it fades into the background or becomes a permanent fixture depends heavily on brain regions handling emotion, memory and threat detection. In most people, those regions gradually learn to filter the signal out as unimportant. In PTSD, that filtering system is already working overtime on something else.

Research into the relationship between stress and tinnitus, including a review of stress hormones and emotional states in tinnitus, describes how disturbance in the body’s stress hormone axis can raise cortisol and affect limbic structures such as the amygdala, areas implicated in both anxiety and tinnitus. The same review notes that reduced tolerance for loud noise appears in both conditions, and that tinnitus can flare when a sound recalls the original event.

When the sound becomes a reminder

This is where tinnitus stops being purely an ear problem. If the ringing began at the moment of the trauma, the brain can treat it as part of the event itself. Signs this may be happening include:

• Noticing the sound most sharply in quiet moments, when there is nothing else to attend to
• Avoiding silence altogether, or avoiding places where the sound feels louder
• A sudden jump in perceived loudness on stressful days
• Feeling on edge or unable to concentrate, without being sure which condition is responsible

Sleep is usually where the two do the most damage together. Hyperarousal makes falling asleep difficult, the quiet bedroom makes the tinnitus more prominent, and broken sleep raises distress the next day, which in turn makes the sound harder to tune out.

What tends to help

There is no cure for tinnitus, and honest information matters more than false hope here. What does help is treating both conditions rather than one:

• Get your hearing properly assessed. An audiologist can identify hearing loss driving the tinnitus, and hearing aids sometimes reduce it considerably. Do not assume it is only stress.
• Use sound enrichment rather than silence. A fan, low background music, or a sound generator gives the brain something else to attend to, particularly at night.
• Consider psychological support. Cochrane’s review of cognitive behavioural therapy for adults with tinnitus found low to moderate certainty evidence that it can reduce the impact tinnitus has on quality of life, with few or no adverse effects. It does not make the sound quieter. It changes your relationship with it.
• Treat the PTSD in its own right. Trauma-focused therapy does not target tinnitus, but reducing hypervigilance often lowers how threatening the sound feels.
• Review medications with your prescriber, since some can worsen tinnitus.
• Protect the hearing you still have, with ear plugs at concerts and around machinery.

Raising it with your GP

Tinnitus is easy to leave unmentioned, particularly when appointments are already full of other things. It is worth naming specifically. A GP can refer you to an audiologist, and a mental health treatment plan can subsidise psychology sessions. Veterans may be able to access hearing services and mental health support through DVA. Describe how the sound affects your sleep, concentration and mood rather than only how loud it is. That is the information a clinician can actually work with.

Living with both is genuinely hard work, and progress tends to be gradual rather than dramatic. But the ringing does not have to stay as loud in your attention as it feels right now.