“Our emotions can play tricks on us. Highly anxious people may feel their body “in the red,” like a race car pushed to its limits. Tinnitus is just one of the possible symptoms when we are under stress.” - Drew Sutton, MD, Board-Certified Otolaryngologist
Anxiety is a disorder whose prevalence continues to increase in our modern world. Whether due to professional demands or daily stress, an unprecedented number of people are experiencing it.
Anxiety comes with many detrimental health consequences: high blood pressure, impaired quality of life, digestive problems, and many others. It is the profoundly interconnected functioning of the human body that largely explains why anxiety can have such marked effects.
One topic is generating increasing interest: the possible link between anxiety and a particular form of tinnitus, pulsatile tinnitus. Classic tinnitus is known to have multiple causes, including stress, but the potential link between anxiety and pulsatile tinnitus remains less well-studied.
Here is a detailed examination of the physiology of anxiety and pulsatile tinnitus, and how these two conditions can overlap.
Anxiety
Anxiety is a form of stress-related disorder, characterized by persistent and excessive worries that do not go away. Anxiety is related to stress, but they are actually two distinct concepts. Stress is a short-term response to a threat, while anxiety can be triggered by nothing more than your own thoughts.
While stress and anxiety fundamentally differ in their triggers and duration, they produce very similar effects on the body. Here's how the body handles perceived threats and why anxiety can harm health in the long run.
The Stress Response
Humans evolved over thousands of years, adapting to changing environments, and needed a way to escape predators. It was with this in mind that, somewhere in the human lineage, the stress response emerged.
The stress response is a physiological reaction to a perceived threat. For prehistoric humans, this threat could be the appearance of a saber-toothed tiger. When a threat is perceived, the body releases stress hormones: cortisol and adrenaline.
Cortisol is a key stress hormone. It increases blood sugar, increases sugar supply to the brain, and improves tissue repair capabilities. At the same time, it reduces immediately non-essential functions, such as digestion, immunity, and reproduction.
Adrenaline is the other stress hormone secreted in response to a perceived threat, and it is responsible for many common symptoms you experience when stressed: increased heart rate, increased breathing, elevated blood pressure, and heightened vigilance.
The combination of cortisol and adrenaline forms the chemical basis of what is known as the fight-or-flight response.
In essence, when your body secretes these two hormones, it prepares for the rapid actions needed to flee the threat or confront it head-on. For our ancestors, this response was most likely a major asset: this immediate gain in performance, vigilance, and heart rate was essential for them to fight back against a predator or to flee.
The Stress Response in Modern Humans
While the stress response was an ideal mechanism for humanity over the millennia preceding the modern era, it must be acknowledged that it is no longer as necessary for survival as it once was.
Its persistence is even partly maladaptive, as the brain poorly distinguishes between what is a physical threat and what is merely stressful.
The perfect example of this maladaptation is being late for work. Your brain interprets the thought "I'm late" as a threat. It then triggers an acceleration of heart rate, breathing, and all those physiological changes… simply so you can sit in traffic, stressed and uncomfortable.
The real problem with stress appears with the possible development of chronic stress. This sets in easily, precisely because the brain struggles to distinguish between physical and non-physical threats.
If the brain becomes too quick to identify threats to deal with, it will continuously secrete stress hormones, which can harm your overall health.
Where Anxiety Comes In
Anxiety can be considered as chronic stress without any real physical basis. In other words, the mere thought of certain things is enough to trigger the stress response: every time you think about it, the body responds by secreting fight-or-flight hormones.
Tinnitus
Tinnitus is a symptom characterized by ringing or buzzing in the ear in the absence of any auditory stimulus. Generally, tinnitus is accompanied by another disorder, such as hearing loss, but it has also been associated with certain medications, anxiety, stress, and other factors.
Tinnitus comes in several forms, including pulsatile tinnitus. This differs from classic tinnitus in that it does not correspond to a constant tone. Instead, the sound of pulsatile tinnitus has a fluctuating quality and almost feels like a beat, hence its name.
Pulsatile tinnitus has many causes, but most of them concern blood circulation around the ear. Hardening of the arteries, high blood pressure, or vascular malformations are considered possible causes of pulsatile tinnitus.
The Link Between Pulsatile Tinnitus and Anxiety
At first glance, pulsatile tinnitus and anxiety seem unrelated, but they are actually closely linked. Once we understand how these two conditions affect the body, obvious similarities emerge that deserve examination.
The first: pulsatile tinnitus typically has a cardiovascular origin, and anxiety can increase cardiac output. This relationship suggests the possibility that anxiety is a potential cause of pulsatile tinnitus.
The second point to note is that tinnitus, in general, can itself cause anxiety. This continuous sound quickly becomes annoying, and when it persists, it can lead to anxiety.
These two elements can set off a formidable cycle in which they feed into each other, leading to much more severe levels of anxiety and tinnitus, capable of significantly impairing your quality of life.
The Formation of a Feedback Loop
The link between pulsatile tinnitus and anxiety is particularly interesting because it illustrates a common phenomenon in people with tinnitus. The two factors mentioned above show that a feedback loop can form and worsen symptoms.
This loop would look like this: anxiety increases blood pressure, which worsens pulsatile tinnitus, which increases anxiety. This self-perpetuating loop can be destructive and ultimately lead to severe consequences for mental health and a decreased quality of life.
Breaking this loop is one of the best ways to prevent tinnitus or anxiety from worsening. Since an increase in one leads to an increase in the other, getting to the root of the problem and breaking the loop is a crucial first step towards finding relief.
What to do?
Now that you know the close link between pulsatile tinnitus and anxiety, you probably want to better understand how to effectively prevent and treat both. Here are the actions to take to limit the risk of a feedback loop forming.
Coping Strategies
Coping strategies refer to how you manage stress. There are healthy and less healthy ways to deal with it, and learning to manage stress can effectively help calm feelings of anxiety.
Healthy strategies include regular physical activity, mindfulness, and meditation. With a little practice at the beginning, you can truly alleviate the tensions associated with anxiety.
When stress is managed healthily, the amount of stress hormones secreted by your body in response to a stressor decreases, bringing welcome relief.
Get Your Tinnitus Treated
Tinnitus is often considered a chronic condition, and many people are unaware that there are actions that can be taken to alleviate its symptoms.
Cognitive-behavioral therapies, Tinnitus Retraining Therapy (TRT), or treating underlying hearing loss can reduce the severity of tinnitus and prevent the feedback loop from setting in. In some cases, a hearing aid can help reduce tinnitus.
Conclusion
In summary, pulsatile tinnitus and anxiety are closely linked, as they both have privileged relationships with the circulatory system.
They are so interconnected that one can become trapped in a feedback loop where anxiety worsens tinnitus symptoms, which in turn fuels anxiety.
Sources:
What is the Difference Between Stress and Anxiety? | APA
Chronic stress puts your health at risk | Mayo Clinic
Cortisol | Hormone
Tinnitus - Symptoms and causes | Mayo Clinic
