July 29, 2009

Review of The Association Between Tinnitus and Posttraumatic Stress Disorder

The author of this article explains the evidence for connections between tinnitus and Posttraumatic Stress Disorder (PTSD). In the initial paragraph he lists several articles that support a co-occurring relationship and related neural mechanisms. The article jumps back and forth in presenting the information and keeps a central focus on PTSD and its impact on assessment protocols. The article is presented in the Journal of Audiology, so this could explain the emphasis on the psychological aspect of the equation. Audiologists have a unique perspective in their field of practice and would not need a substantial explanation of auditory pathology, hence the concentration on the psychological effects and the similarities in treatments for both PTSD and tinnitus.

The paper details the similarities in diagnostic criteria for symptoms of increased arousal compared to the diagnostic criteria for tinnitus, such as difficulty in falling asleep, irritability or outburst of anger, difficulty concentrating, hypervigilance and exaggerated startle response. The symptoms of sleep disorder and concentration difficulties translate directly to tinnitus screening measures along with hypervigilance and exaggerated startle response as relational to irritation and anger associated with tinnitus. The overlap of symptoms suggests that the presence of both diagnoses would exacerbate either condition bi-directionally. Of 300 patients studied, 34% had both conditions.

The author suggests that clinical evaluations and mental health screenings, when dealing with trauma related disorders and audiology assessments should include screening criteria for both tinnitus and PTSD. He suggests that audiology testing should incorporate sensitivities to patients with diagnosed and undiagnosed PTSD, as the startle responses could be increased with the sudden tones and high pitches related to auditory testing. Many patients self-report of the resounding silence within the sound booth as an anxiety stressor, and listed many offending characteristics of the hearing screening regimen.

One word used throughout the paper that struck me as possibly harmful in translation to the population was the repeated use of the word “complaint” and its many variations. The medical model uses many such words in addressing medicalized “problems” which maintain a distance between the medical profession and patients. With and understanding of comorbid etiology, social workers can better assess the individuals situation and provide a better chance of successful outcomes in treatment and referrals more conducive to the clients best interest. Recognition of treatment modalities that could benefit both conditions, the client can find relief from an efficient use of time and techniques employed by the educated social worker. Treatments indicated to work in both conditions are antidepressants and cognitive-behavioral therapy.

Fagelson, M. A. (2007). The association between tinnitus and posttraumatic stress disorder. American Journal of Audiology, 16, 107-117.


  1. Mr. Lee:
    Thank you for pointing out the potential loaded meaning of "complaint." I will try to do a better job in the future of selecting more neutral wording. Just so you know, our patient population is now more than 800, and we see the same (if not a slightly higher) prevalence of PTSD among our patients with tinnitus, relative to the time period covered in the article you mention.

    1. Thank you Marc for taking the time to comment, I thought you did an excellent job of detailing tinnitus and PTSD. The point raised was the only critical part I could find for a review of a peer-reviewed article for college. To the chagrin of my professors I wrote 99% of my papers about veteran issues and I snuck this topic in on that one word. I got an A- because it wasn't critical enough.

      It took many years to become acclimated to living with tinnitus, I would have benefited greatly had it been addressed early in therapy, as it can trigger flashbacks and dissociative episodes. Additionally, heightened anxiety causes the volume of tinnitus to increase. During times of great stress it can be so loud I cannot hear over it even with my hearing aids.

      I applaud your work, thank you for working on the forefront of an area that benefits veterans. Your work is a valuable tool for the mental health practitioner and should be disseminated throughout the VA as standard protocol for patients with PTSD and TBI.

  2. As someone with PTSD and Tinnitus, as well as physical traumatic brain injury, I find the general lack of understanding around me to be quite problematic, and this does either set back my recovery, and can also make my symptoms worse. It is difficult often to want to continue living, as life has become so painful, and it would help me if there wasn't such prolific distribution of loud noise, including music, in public spaces. I realise that I am not alone - there are other sufferers out there, but each day and instance that I am confronted by the assaults from these loud noises I am very much alone. My peace of mind is stolen from me, my senses abused and any feelings I had of well-being and safety desert me. If I try to explain and ask for help, such as by someone lowering sound levels, I am not typically understood. At such times I'm typically upset and am not in the best frame of mind to be viewed as rational and perhaps not 'deserving' of help.

    Invisible disabilities are the disability world's poorer cousin. Not only are our disabilities invisible, but we as individuals become invisible too, as we avoid situations and others, as well as communicating with people who may potentially help.

    We also should not be expected to be the most informed experts on why a causes b, as seems to be demanded very frequently out there, by people that I request help or adjustments from. I'm just trying to live my shattered life now, and make today just a little better and more tolerable than yesterday was, when I seriously wanted to give up on life. Seemingly I have to justify what is needed to help help steer the course of my life in a healthier direction - I may have been making a small request, at a time and place where I couldn't cope with what someone's organization was doing to me, such as infringing upon my personal feelings of safety, by bombarding me with sound, but hey, you demanded to know why, why I was important, who I really thought I was to demand such changes, when everyone else is perfectly happy etc.

    I'm just a wounded person, crying in isolation, despairing because others demand so much of me, at the points where I'm weakest and I'm looking for support, others to help alongside, rather than stigmatise and further isolate me.

    I really appreciate any expert in associated fields, such as hearing, psychology etc finding out how they may be able to use their research and expertise to help make the world for people like me to become a brighter place than it is right now. Thank you to anyone who is helping to build upon what we know, and forge the links between the various disciplines out there, the multiple medical / support functions. I'm not a rich man, but you have the riches from my heart for wanting to make things better, in this seemingly tough world that we live in.

  3. Rob, thank you for taking the time to write such a well written response. I started my journey here on this blog because of the emotional pan I was in and how that resonated with me and our new generation of help seeking veterans. I wanted to share about how we think and feel and try and explain my thinking process. It evolved into an online community that now extends to Facebook. In Feburary of this year I was asked to run a page with over 14,000 members. Since then we've grown the site to almost 19,000 and it's still growing. If you would like to join our main support group at https://www.facebook.com/groups/VeteransPTSDprojectSupport/ and you can check out our FB page at https://www.facebook.com/veteransptsdproject. Come join us there for support and resources.


Please share your comments, stories and information. Thank you. ~ Scott Lee