Stress and tinnitus

Stress und Tinnitus


Emotional stress is a constant companion of tinnitus patients, since this phantom sound can unfortunately be a very effective stressor. However, the mechanism of stress contribution to the onset or progression of tinnitus remains unknown. Here, we review the pathways induced by emotional stress and the outcome of their induction: corticosteroid-dependent changes in gene expression, epigenetic modulations, and impact of stress on neuronal plasticity and neurotransmission. Using clinical examples, we demonstrate the presence of emotional stress among tinnitus patients and we present methods to measure the degree of stress. The evidence causally linking emotional stress with tinnitus is still indirect—the main difficulty lies in the inaccessibility of human auditory tissues and the inability to directly measure tinnitus-induced psychological distress in animal models. However, we believe that translational research is the future way of filling this gap, finding the answers, and thereby improving both the diagnosis and treatment of tinnitus patients.


Emotionaler Stress ist ein wesentliches Begleitsymptom von Tinnituspatienten, da dieser Phantomton oder dieses Phantomgeräusch ein direkter effektiver Stressfaktor sein kann. Der Mechanismus – Stress –, der zur Entstehung oder Progression von Tinnitus beiträgt, ist jedoch bis jetzt nicht komplett aufgeklärt. Die durch emotionalen Stress induzierten Signalwege und deren Folgen sind: kortikosteroidabhängige Veränderungen in der Genexpression, epigenetische Modulationen, Auswirkungen auf die neuronale Plastizität und Neurotransmission. Anhand klinischer Beispiele ließ sich das Vorliegen von emotionalem Stress bei Tinnituspatienten zeigen. In diesem Zusammenhang sind besonders Methoden zur Messung des Stressgrads im diagnostischen Setting sehr wichtig. Kausale Beweise, die emotionalen Stress mit Tinnitus verknüpfen, sind weiterhin indirekt – die Hauptschwierigkeit liegt zum einen im fehlenden Zugang zum menschlichen auditorischen Gewebe und zum anderen in der mangelnden direkten Übertragbarkeit der Grundlagenaspekte aus der tierexperimentellen Forschung auf den Menschen. Gerade deshalb ist die translationale Forschung der zukünftige Weg, um diese Wissenslücke zu schließen und Antworten zu finden sowie damit letztendlich Diagnostik und Behandlung von Tinnituspatienten auch im Hinblick auf die Stressexposition zu verbessern.

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Compliance with ethical guidelines

Conflict of interest. B. Mazurek, A.J. Szczepek, and S. Hebert state that there are no conflicts of interest. All national guidelines on the care and use of laboratory animals have been followed and the necessary approval was obtained from the relevant authorities.

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Correspondence to Prof. Dr. B. Mazurek.

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Mazurek, B., Szczepek, A. & Hebert, S. Stress and tinnitus. HNO 63, 258–265 (2015).

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  • Emotional stress
  • Tinnitus
  • Translational research
  • Homeostasis
  • Auditory system


  • Emotionaler Stress
  • Tinnitus
  • Translationale Forschung
  • Homöostase
  • Auditorisches System