Why Is My Tinnitus Getting Worse?

You are here because it was quieter last week and today it is not.

When a level meter jumps, an engineer first asks whether the signal changed or the meter did. Same habit here.

This page sorts it by time. Hours to days is one situation. Weeks is another. A few signs, at any speed, are a third, and those mean you get seen.

Is my tinnitus really getting worse, or is this a spike?

“Spike” is the word people with tinnitus use for a loud stretch that arrives, is miserable, and then eases. It is the community’s word, not a diagnosis.

The useful question is how long it has lasted.

• Hours to a few days. Treat it as a spike. The next section covers what usually sits behind one.
• Weeks, and not easing. That is a hearing-test question. It has its own section below.
• Any length, with one of the four signs further down. Get seen.

I could not find a study that timed spikes, so I will not give you a number.

Why is my tinnitus louder than usual today?

Nobody has found one cause for a loud day, and the best data I found explains why.

In one app study, 278 users answered a daily survey on tinnitus loudness and distress, mood, stress and concentration. No single rule held across the whole group. For most individuals, though, the analysis found a personal pattern that involved things like mood, stress and how aroused they felt, on the same day and the day before.

So you are looking for your own trigger, not a universal one. These are the things with something behind them:

• A bad night, or the small hours. In 17,209 phone ratings from 350 people, tinnitus was louder and more distressing between midnight and 8 a.m. If “so loud today” means 3 a.m., that is the known pattern.
• Stress and mood. They showed up in that app study for many individuals. Not for everyone, and not as a rule.
• Loud noise. A 2021 physician review says avoiding noise may help prevent tinnitus from developing or getting worse over time. It does not say a loud night explains today’s spike, so I will not claim that.
• A new medicine. In the UK Biobank analysis, medicines that can harm hearing were linked to having tinnitus and to having bothersome tinnitus. If a new prescription lines up with the change, tell the prescriber or pharmacist. Do not stop it on your own.
• Something in the ear. A physical exam can find treatable causes, which is why the 2014 guideline starts with one.

What if my tinnitus keeps getting louder for weeks?

Then it is a different question, and the answer is a hearing test.

The largest long-term data I found come from the UK Biobank. Researchers asked 4,746 adults about tinnitus twice, four years apart. Among people who still had tinnitus, about 9% said it had become more bothersome and about 9% said less bothersome. The rest said no change.

More bothersome is not always the same as louder. It is the measure that study used.

The authors’ summary was that improvement and worsening were equally likely. The factor linked to tinnitus becoming more bothersome was trouble hearing.

That is why the 2014 US guideline asks for a prompt full hearing exam when tinnitus is in one ear, has lasted six months or longer, or comes with trouble hearing. If your hearing is changing, that is the thing to catch.

When is louder tinnitus a reason to see someone now?

Some changes should not wait for a trend. Four signs:

• It is louder in one ear only, or much more in one ear.
• Your hearing dropped or feels muffled, especially on one side. Sudden hearing loss can come with tinnitus. The 2019 guideline says it often prompts an urgent visit, and that prompt treatment may improve recovery.
• It beats in time with your pulse. Pulsatile tinnitus has its own workup, and a 2022 review says a cause is found in more than 70% of people who get a thorough one.
• Dizziness, numbness or weakness, trouble speaking or seeing, or a sudden severe headache. The CDC lists these as stroke signs and says to call 911 right away.

When the sound is steady, in both ears, and nothing else changed, the guideline advises against brain scans. That is the ordinary case.

What can I do while it is up?

• Judge it over weeks, not hours. A bad Tuesday tells you little. A bad month tells you something.
• Protect sleep. The small hours are the loudest part of the day in the phone data, and sleep has a trial behind it. The article on tinnitus and insomnia covers it.
• Do not check it every hour. In my experience, checking is listening, and listening is the thing you are trying to do less of.
• Do not buy your way out of a bad week. The guideline recommends against ginkgo, melatonin, zinc and other supplements for persistent, bothersome tinnitus. My page on supplements goes through what the trials found.

FAQ

Will my tinnitus go back down?

Over four years, people who still had tinnitus were as likely to find it less bothersome as more. Nobody can tell you when yours will ease, and I found no study that timed spikes.

How long does a tinnitus spike last?

I could not find a study that measured it. The clock that matters is different: hours to days is a spike, and weeks without easing is a hearing-test question.

Can stress make tinnitus louder?

In the daily-rating study, stress, mood and arousal were tied to loudness and distress for many individuals. It was a personal pattern, not a rule for everyone.

Does louder tinnitus mean my hearing is getting worse?

It can go with it. In the UK study, trouble hearing was linked to tinnitus becoming more bothersome. A hearing test is how you find out.

Should I go to the emergency room?

For sudden weakness, numbness, trouble speaking or seeing, or a sudden severe headache, call 911. For sudden hearing loss, the guideline describes an urgent visit, so call a doctor today rather than next week.

None of the four signs applies. Is it safe to wait?

Then you are in the situation the rest of this page covers: watch it over weeks, and book a hearing test if it holds. If any one of the four applies, do not wait.

Sources

1. Dawes P, Newall J, Stockdale D, Baguley DM. Natural history of tinnitus in adults: a cross-sectional and longitudinal analysis. BMJ Open, 2020 Dec;10(12):e041290.
2. Simoes J, Bulla J, Neff P, Pryss R, et al. Daily Contributors of Tinnitus Loudness and Distress: An Ecological Momentary Assessment Study. Frontiers in Neuroscience, 2022;16:883665.
3. Probst T, Pryss RC, Langguth B, Rauschecker JP, et al. Does Tinnitus Depend on Time-of-Day? An Ecological Momentary Assessment Study with the “TrackYourTinnitus” Application. Frontiers in Aging Neuroscience, 2017;9:253.
4. Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, et al. Clinical practice guideline: tinnitus. Otolaryngology-Head and Neck Surgery, 2014 Oct;151(2 Suppl):S1-S40.
5. Chandrasekhar SS, Tsai Do BS, Schwartz SR, Bontempo LJ, et al. Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngology-Head and Neck Surgery, 2019 Aug;161(1_suppl):S1-S45.
6. Narsinh KH, Hui F, Saloner D, Tu-Chan A, et al. Diagnostic Approach to Pulsatile Tinnitus: A Narrative Review. JAMA Otolaryngology-Head & Neck Surgery, 2022 May;148(5):476-483.
7. Dalrymple SN, Lewis SH, Philman S. Tinnitus: Diagnosis and Management. American Family Physician, 2021 Jun 1;103(11):663-671.
8. Centers for Disease Control and Prevention. Signs and Symptoms of Stroke. cdc.gov/stroke/signs-symptoms.