Pulsatile Tinnitus and Anxiety: Are They Related?
November 01, 2021

“Our emotions can play tricks on us. Those with heightened anxiety can experience their bodies “red-lining,” just like a racecar being pushed to the limits. Tinnitus is only one of the possible symptoms when we are under stress.”   - Drew Sutton, MD, Board-Certified Otolaryngologist

Anxiety is a condition that continues to grow in prevalence in today’s modern world. Whether it be the demands of work or the everyday stresses of life, an unprecedented number of individuals experience anxiety. 

With anxiety comes the potential for several detrimental health impacts such as high blood pressure, poor quality of life, G.I. problems, and many more. The interconnected nature of the human body is a large reason why anxiety can have such profound effects on the human body. 

A recent area of interest is the potential relationship between anxiety and a form of tinnitus known as pulsatile tinnitus. Standard tinnitus is known to have several different causes, including stress, but the possible link between anxiety and pulsatile tinnitus is not as well researched. 

Below is a closer look at the physiology behind both anxiety and pulsatile tinnitus and how these two conditions may overlap.


Anxiety is a form of stress disorder characterized by persistent and excessive worries that do not go away. Anxiety is related to stress, but the reality is that they are two different concepts. Stress addresses the short-term response to a threat, while anxiety can be triggered by seemingly nothing other than your thoughts. 

While stress and anxiety are fundamentally different in terms of triggers and duration, they can have very similar effects on the body. Below is a closer look at how the body deals with perceived threats and why anxiety can lead to poor health outcomes in the long run. 

The Stress Response

Humans have evolved over thousands of years and adapted to changing environments, and needed a way to evade predation. Toward this goal, somewhere in the lineage of humans, the stress response was created.  

The stress response is a physiological response to a perceived threat. For ancient humans, this perceived threat could have been seeing a sabertooth tiger. When a threat is perceived, the body releases the stress hormones cortisol and adrenaline.

Cortisol is a key stress hormone that acts by increasing blood sugar, increasing brain intake of sugar, and increasing the capacity for tissue repair. The hormone also simultaneously reduces immediately non-essential functioning in the body, 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 of the common symptoms you may experience when you are stressed. This includes an elevation of heart rate, increased respiration, elevated blood pressure, and increased alertness. 

The combination of cortisol and adrenaline is the chemical basis for what is known as the fight or flight response. 

Essentially when your body secretes these two hormones, the body is prepared to make the necessary fast actions to either evade the threat or tackle it head-on. For our ancestors, this response was likely to be highly advantageous as the quick boost in performance, alertness, and heart rate was likely needed to either fight back against a predator or to run away. 

Stress Response In Modern Humans

While the stress response was an ideal mechanism for humans in the thousands of years leading up to the modern era, the reality is that the system is not as needed as it once was for survival. 

Its presence is somewhat maladaptive because the brain is a poor discriminator between what is a physical threat and what is simply stressful. 

A great example of how the stress response is maladaptive is if you’re late for work. Your brain takes the thought of being late as the perceived threat. It then moves forward to increasing heart rate, respiration rate and initiating all of these changes at a physiological level just for you to sit during your commute feeling stressed out and uneasy. 

The problem with stress truly comes into play with the potential development of chronic stress. Chronic stress can occur easily with the brain’s inability to discern between physical threats and non-physical threats. 

If the brain becomes too trigger-happy with identifying actionable threats, it will continuously secrete stress hormones which can be bad for your overall health. 

Where Anxiety Fits In

Anxiety can be thought of as chronic stress with little to no physical basis. Simply put, the mere thought of certain items can induce the stress response, and any time you think about it, the body responds by secreting fight or flight hormones. 


Tinnitus is a symptom that is characterized by a ringing in the ear in the absence of auditory stimuli. Generally, tinnitus is accompanied by something else such as hearing loss, but it also has been linked to certain medications, anxiety, stress, and more. 

Tinnitus comes in several different forms, and one of those is known as pulsatile tinnitus. Pulsatile tinnitus differs from typical tinnitus in that pulsatile tinnitus is not a constant tone. Rather the tone from pulsatile tinnitus tends to have a wave-like form and almost feels pulsing, hence the name. 

Pulsatile tinnitus has many different causes, but most of them have to do with the blood flow surrounding the ear. Hardening of the arteries increases blood pressure, or even blood vessel malformations are thought to cause pulsatile tinnitus. 

The Connection Between Pulsatile Tinnitus and Anxiety

Pulsatile tinnitus and anxiety on the surface seem unrelated, but in reality, they are quite related to one another. Knowing how both of the conditions impact the body, some very obvious similarities are worth investigating. 

The first is that pulsatile tinnitus typically has a cardiovascular cause, and anxiety can increase cardiac output. This relationship shows the possibility for anxiety to be a potential cause for pulsatile tinnitus. 

The second aspect to note is that tinnitus, in general, is a condition that can invoke anxiety in individuals. The constant pitch can become annoying, and when persistent, it can lead to anxiety. 

These two components can lead to a very slippery slope where they feed off of one another and can lead to more severe levels of anxiety and tinnitus that can drastically impact your quality of life. 

Feedback Loop Formation

The connection between pulsatile tinnitus and anxiety is unique because it illustrates a common phenomenon experienced by those with tinnitus. The two factors above illustrate the possibility of forming a feedback loop that can lead to exacerbated symptoms. 

The feedback loop would look something like feeling anxious leads to high blood pressure, which leads to worsened pulsatile tinnitus, increasing anxiety. This self-fulfilling feedback loop can be damaging and ultimately lead to poor mental health consequences and decrease your overall quality of life. 

Breaking the feedback loop is one of the best ways to reduce developing more severe tinnitus or anxiety. An increase in one could lead to an increase, so getting to the bottom of it and cutting the feedback loop can be a significant first step to seeking relief. 


Now that you know the interconnected relationship of pulsatile tinnitus and anxiety, you may want to understand better how you can prevent and effectively tackle either situation. Below are actions you can take to help mitigate the chances of feedback loop formation and more. 

Coping Techniques

Coping techniques represent the ways that you deal with stress. There are both healthy and unhealthy ways that people deal with stress, and trying to manage stress can potentially help with feelings of anxiety effectively. 

Healthy coping techniques include getting routine exercise, practicing mindfulness, and meditating. With a little bit of initial practice, you can effectively mitigate the stresses associated with anxiety. 

When stress is dealt with healthily, it can reduce the level of stress hormone your body secretes due to a stressor and provide you with some much-needed relief. 

Seek Tinnitus Treatment

Tinnitus is often thought of as a chronic condition, and many people do not realize that you can take actions to help with tinnitus symptoms potentially. 

Cognitive-behavioral therapy, tinnitus retraining therapy, or even treatment for underlying hearing loss can help mitigate tinnitus severity and help prevent the feedback loop from occurring. In some instances, a hearing aid can help to mitigate tinnitus. 


In summary, pulsatile tinnitus and anxiety are closely related because they typically both have close ties to the circulatory system. 

Both anxiety and pulsatile tinnitus are so interconnected that individuals can get caught in a feedback loop where anxiety increases tinnitus symptoms, and those symptoms lead to further anxiety. 



What's the difference between stress and anxiety? | APA

Chronic stress puts your health at risk | Mayo Clinic

Cortisol | Hormone 

Tinnitus - Symptoms and causes | Mayo Clinic

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Drew Sutton M.D.

Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.

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