Tinnitus is the perception of sound, such as ringing, buzzing, or hissing, when no external acoustic source is present. This phenomenon affects millions of people, and for those who already experience it, symptoms can suddenly increase in volume or intrusiveness, an event commonly called a flare-up. Understanding these flare-ups means recognizing that they rarely have a single cause, but are instead often triggered by a combination of external and internal factors. The specific triggers that cause tinnitus to worsen are highly individual, but they generally fall into predictable categories that affect the auditory system or the brain’s processing centers.
Acoustic Environment and Noise Exposure
The most direct and common trigger for a temporary or prolonged spike in tinnitus severity is exposure to loud sound. Loud noises can cause temporary acoustic trauma, which places immediate stress on the delicate hair cells within the inner ear’s cochlea. This stress often leads to a temporary increase in the perceived loudness of existing tinnitus.
Exposure does not need to be instantaneous, as prolonged noise from sources like heavy machinery, loud music, or continuous city traffic can have a cumulative effect. Even everyday sounds can cause a spike in reactive tinnitus for some individuals, where the auditory system becomes hypersensitive. This means sounds like running water or a refrigerator hum can temporarily amplify the internal noise.
Avoiding excessive noise is one of the most effective ways to prevent flare-ups. Using hearing protection, such as earplugs or earmuffs, in loud environments is a necessary protective measure. Reducing the volume on personal listening devices also helps minimize exposure to damaging sound levels.
Medications and Dietary Factors
Ingested substances can chemically affect the inner ear, auditory nerve, or circulatory system, leading to a tinnitus flare-up. Medications that cause damage or exacerbate symptoms are termed ototoxic; over 200 prescription and over-the-counter drugs have been identified as potential triggers. High doses of non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, for instance, are known to temporarily worsen tinnitus.
Certain classes of antibiotics, such as aminoglycosides, and specific chemotherapy agents, particularly platinum-based drugs like cisplatin, are associated with ototoxicity that can lead to more lasting changes in tinnitus severity. Loop diuretics, commonly prescribed water pills, may also cause temporary tinnitus that resolves once the medication is stopped. It is important to consult a physician immediately if a new medication appears to be worsening symptoms, but never stop a prescribed drug without medical guidance.
Dietary choices can also act as powerful triggers by impacting blood flow and nervous system excitation. Stimulants like caffeine and nicotine increase blood pressure and nervous system activity, which may result in a more pronounced perception of tinnitus. High sodium intake can affect the fluid balance and circulation within the inner ear, making the internal sound more noticeable. Alcohol is another common trigger that temporarily dilates blood vessels, altering blood flow near the ear and sometimes causing a spike in symptoms.
Stress and Emotional State
The brain plays a significant role in determining the severity of tinnitus, and the emotional state has a direct impact on how the sound is perceived. Chronic stress, anxiety, and sudden emotional shock trigger the body’s fight-or-flight response, releasing hormones like cortisol and adrenaline. This response heightens sensory awareness and causes the central nervous system to become more vigilant.
When the nervous system is in this state of heightened alert, the brain is less effective at filtering out the phantom noise, making the existing tinnitus sound louder and more intrusive. This creates a difficult feedback loop where the perceived increase in tinnitus severity causes greater stress and anxiety, further amplifying the sound. Lack of sleep and fatigue are closely linked to this mechanism, as a tired brain is less able to process and habituate to the tinnitus signal.
Chronic stress can also cause muscle tension in the head and neck, including the muscles around the ear and jaw, which can physically contribute to the amplification of the sound. Managing the body’s response to stress through techniques like mindfulness or cognitive behavioral therapy is often an effective strategy for reducing tinnitus flare-ups. The connection between stress and tinnitus involves biological changes in how the brain processes auditory information.
Localized Physical and Systemic Health Issues
Physical and mechanical changes in and around the ear can cause a temporary increase in tinnitus symptoms. Excessive ear wax buildup, for example, can press against the eardrum or physically block sound conduction, which can cause the brain to increase its baseline auditory gain, resulting in a louder tinnitus sound. Acute conditions like middle ear infections or sinus congestion can also increase pressure within the middle ear, temporarily worsening symptoms until the inflammation subsides.
Issues outside the ear, such as Temporomandibular Joint (TMJ) dysfunction, can irritate nerves that are shared with the auditory system due to the close anatomical proximity of the jaw joint. Clenching or grinding the teeth can transmit physical tension to the inner ear, leading to a temporary or prolonged spike in tinnitus severity. Systemic health issues that affect circulation, like uncontrolled high blood pressure or other vascular disorders, can also make pulsatile tinnitus more noticeable.
These conditions cause blood to move with greater force, and if the sound of blood flow is transmitted to the inner ear, the internal noise will be amplified.