A physiological correlate for the intolerance to both internal and external sounds

The notion that stress can induce chronic tinnitus, or increase its intensity, is predominant in the literature on tinnitus. However, there is little empirical support for this claim, since previous studies rely merely on subjective reports. In the present study, we used an objective physiological measure of stress (i.e., basal secretion of the stress hormone cortisol), in order to assess the relationship between tinnitus and stress. We hypothesized that tinnitus, a permanent internal sound, should behave as a stressor and should be accompanied by chronically elevated cortisol levels in individuals with severe tinnitus. In addition, we hypothesized that suffering from severe tinnitus should generalize to an intolerance towards external sounds. Two groups each comprised of 18 participants (with and without tinnitus) matched on education and health status participated in the study. Tinnitus severity, as assessed by tinnitus-related distress, was high in half of the tinnitus participants, and low in the other half. Basal cortisol levels were measured using saliva samples (five saliva samples per day for 3 days within a week) taken in the participant's natural environment. Intolerance to external sounds was assessed psychometrically. The high tinnitus-related distress group had chronic cortisol levels greater than both the low tinnitus-related distress and control groups, and also displayed greater intolerance to external sounds. The low tinnitus-related distress and control groups did not differ from each other on either of these measures. Our study thus provides the first physiological and empirical evidence of a link between intolerance to both internal (tinnitus) and external sounds in persons with tinnitus, and is compatible with the clinical observation that severe tinnitus is associated with high stress levels.