The loud ringing in your head? That’s tinnitus—how anxiety can make it worse and ways to manage it

The ringing, sigh, the relentless ringing.

“It’s just one long, monotonous siren,” laughs Dubai-based Arundhati Mudliar, a homemaker. She didn’t always have this ringing, tinnitus as it is called: It began as an after-effect of suffering COVID in 2022. On some days particularly, it felt loud and unbearable. It didn’t stop. Nothing softened it.

On those days, she felt plagued by headaches and exhaustion. “I just felt so depressed about everything in my life, even though I had everything that I always dreamed of: A loving husband and two children. But this ringing; it didn’t let me sleep at nights. And somehow, it acted up more in the heat. That ringing, was all that I could hear,” she says.

After two years of trying to settle for an uneasy unacceptance, she went for an audiometry test, only to learn that the tinnitus was connected to hearing loss.  “And so, I now wear a hearing-aid. That tested my resolve and will even more, but I’m just trying to make peace with it,” acknowledges Mudliar.

As doctors explain, tinnitus is when you hear ‘phantom’ noises, which could range from buzzing, whooshing, hissing to ringing sounds. While tinnitus is typically harmless, cases like Mudliar's can raise concerns about your hearing. It’s always best to have it evaluated by a healthcare professional.

What causes tinnitus?

The causes of tinnitus are many.

It isn't a generalised brain reaction to hearing loss, but rather a direct result of a physical, structural, or neurological issue in the ear or surrounding anatomy. It can be the consequence of tumours, nerve issues, build-up of earwax, or damage to the bones behind eardrums. Typically, it occurs in one ear, and it can resemble the sound of a heartbeat. If you hear that, it’s imperative to check with a doctor.

In certain cases, tinnitus may not be a high-pitched ring but a rhythmic thumping or whooshing sound in sync with your heartbeat, which is a condition known as pulsatile tinnitus. In such cases, the tinnitus is caused by asymmetries or abnormalities in the blood vessels near the ear or brain, such as:

Holes in the eardrum:

The eardrum, or tympanic membrane, is a thin structure that vibrates with sound. Infections or sudden pressure changes can lead to tears or perforations, affecting how sound travels to the middle ear. This can result in tinnitus, muffled hearing, or a feeling of fullness in the ear. Furthermore, eardrum perforations also increase the ear’s vulnerability to infections, compounding the symptoms.

In other cases, excessive earwax can press against the ear canal, distorting sound and amplifying the internal noises like blood flow or jaw movement. In these cases, tinnitus often improves or resolves entirely after the blockage is removed. According to a 2013 study published in Otolaryngology–Head and Neck Surgery, the presence of middle ear effusion can significantly alter hearing thresholds and lead to perception of internal sounds, often misinterpreted as tinnitus.

Another study published in PLoS One, a hole in the eardrum or ongoing ear infections can cause hearing problems and ringing in the ears, especially in areas where access to medical care is limited.

Moreover, loud concerts, background noise, earphones can aggravate tinnitus more, so it is necessary to ensure proper ear protection, explains Ananya Dey, a physician based in India.

How tinnitus can cause depression

Most of the time, tinnitus is harmless, just an annoying sound in your ear that refuses to go away. But that doesn’t mean it’s easy to live with. As  Dey explains, “It can mess with your sleep, drain your energy, and in some cases, even lead to depression.”

And while anxiety may not directly cause tinnitus, it can definitely make it worse. “Stress and anxiety can trigger flare-ups or make the ringing feel more intense,” she adds.

Science backs this up. A 2006 study published in Psychosomatics found that people dealing with severe tinnitus were much more likely to have anxiety or depression. Basically, the more intrusive the sound, the harder it hits emotionally.

A 2016 review went even further, describing tinnitus as a chronic stressor that can lead to clinical depression, anxiety disorders, or even insomnia—especially when it’s loud or unrelenting.

In fact, another study in the Brazilian Journal of Otorhinolaryngology found a clear link: the more severe the tinnitus, the more intense the depression tended to be.

What can you do about tinnitus?

There are several effective ways to manage it, even if there's no universal cure yet. Treatment often depends on the underlying cause and the impact it's having on your quality of life. Here’s a breakdown of what can help, explain the experts:

Identify the underlying cause:

The first step is a thorough evaluation by an ENT specialist or audiologist. They may check for:

If a treatable cause is identified, addressing it can sometimes resolve the tinnitus entirely.

Sound therapy

Sound therapy helps reduce the perception of tinnitus by adding external noise to distract the brain from the internal ringing. Options include:

Cognitive behavioural therapy

CBT is one of the most evidence-based approaches for reducing tinnitus-related distress. While it doesn't eliminate the sound itself, it helps:

·         Reframe negative thoughts about tinnitus

·         Reduce anxiety, depression, and emotional reactivity

·         Improve sleep and overall quality of life

A 2012 study showed that CBT can significantly help with coping and reduces the emotional impact of tinnitus.

Hearing aids

For individuals with hearing loss, hearing aids can help in two ways:

Amplifying external sounds, which masks the tinnitus

Improving communication, which reduces the frustration often linked to tinnitus

Lifestyle and stress management

Tinnitus often worsens with stress, fatigue, and poor health habits. Helpful lifestyle changes include:

Practising relaxation techniques

·         Getting regular exercise

·         Reducing caffeine, which can aggravate symptoms in some people

·         Maintaining consistent sleep routines

·         Managing stress doesn’t cure tinnitus, but it can make it much more bearable.