Hearing problems are not among the most common symptoms of multiple sclerosis (MS), but they do occur. Some people experience temporary or permanent hearing loss (deafness), while others experience a symptom called tinnitus — hearing ringing or sounds not caused by an external source.

Tinnitus can be frustrating — and can even impact your mental health or quality of life. However, when you understand how tinnitus is related to MS and what you can do about it, you and your doctor can find a treatment plan that will work for you.

What Is Tinnitus Like With MS?

MyMSTeam members have talked about the tinnitus they experience. “Does anyone have Morse code tapping in the ear?” asked one member. “It feels like my ear muscle has gone into spasm. Hence the ‘Morse code’ sound, which is driving me nuts!” They added that “The ‘morse-like tapping’ isn't painful. It’s uncomfortable and actually feels like a muscle spasm.”

Another member shared that they experience something similar: “I get a clicking, rhythmic tapping in one ear only?! It comes and goes … I would assume it is some kind of nerve irritation!!!”

Some people experience tinnitus in certain situations. As one member shared, “I have tinnitus, which can be aggravated by sounds. Sometimes my husband's snoring does it to me. It almost feels like my eardrums are being sucked in and blown out.”

Clearly, tinnitus can feel bothersome — or even downright maddening. Here is what you should know about tinnitus and MS.

What Causes Tinnitus in MS?

Tinnitus occurs when the brain perceives a sound coming from inside your head or your ear. Tinnitus symptoms include a repetitive sound, similar to the tapping resembling Morse code mentioned by members. It could also manifest as:

• Whistling
• Buzzing
• Whooshing
• Screeching
• Ringing

Health care experts believe that most tinnitus in people with MS is caused by demyelinating damage to the brainstem. Demyelination refers to the process of one’s autoimmune system wearing away at the fatty protective sheathing, called myelin, surrounding one's nerves.

Lesions caused by myelin loss of the auditory nerve, or in closely related pathways, may also cause tinnitus. These lesions cause nerve damage that can hinder or confuse the electrical messages sent from the nerves to the brain, which can result in tinnitus.

Tinnitus in MS also may be caused by ear muscle or eardrum spasms that affect the small bones in and around the ear. This type of tinnitus is called middle ear myoclonus (MEM), and it occurs rarely.

In MEM, bones in the middle ear contract repeatedly, which creates a clicking sound. This is a rare symptom of MS, and researchers aren’t sure how often it happens. It’s common enough, however, that researchers have written case studies about it. As with non-MEM tinnitus, MEM in MS is believed to be tied to lesions that affect the ways these specific muscles function.

Note that the development of tinnitus, as well as any sudden change in hearing or in the inner ear, may indicate an MS flare. If you’re experiencing these types of symptoms for the first time, contact your neurologist. Your health care team can help you manage these and other symptoms of a flare.

Other Causes of Tinnitus Not Related to MS

Tinnitus has a variety of common causes, not all of which stem from MS. Other possible causes include:

• An ear infection
• A blockage in the ear, like excessive ear wax
• Close exposure to very loud noise, like an explosion or excessively loud music
• Hearing loss that has damaged the small hairs inside the ear (cilia)
• Certain medications (taken for conditions other than MS)
• Trauma or injury to the head or neck.

Various tumors, neuromas, and Ménière’s disease also can cause tinnitus. Thus, if you begin experiencing tinnitus for the first time, it’s time to see your doctor. Your neurology team may direct you to an audiologist, who will help you rule out other causes of tinnitus and, if necessary, determine whether your MS is causing it.

Managing Tinnitus With MS

There are a number of tinnitus treatment options available. Some of these are specific to certain causes, while others will help you deal with tinnitus regardless of its origin.

Deal With the Underlying Cause

If your tinnitus is caused by an underlying condition other than MS, then dealing with that condition could reduce your symptoms. You may need to:

• Treat an ear infection
• Remove earwax that is blocking the ear canal
• Use hearing aids to help with hearing loss
• Change your medication
• Undergo treatment for a head or neck injury that is affecting your ears

Medications

There are a number of medications available that help with tinnitus. These include:

• Alprazolam
• Amitriptyline
• Clonazepam
• Nortriptyline
• Oxazepam

Clonazepam, specifically, has helped people who have MEM and MS, though it doesn’t help in all cases. Your doctor can help you manage these medications along with your MS medications and ensure that you experience as few side effects as possible from treating both conditions.

Sound Therapy

Sound therapy uses naturally occurring sounds to help suppress the tinnitus you experience. The noise needs to be steady, nonmeaningful, nonintrusive, and easy to ignore. This decreases the strength of the tinnitus and can help people sleep or complete other daily activities.

Noise or Music Suppression

Sometimes, tinnitus doesn’t go away, but you can mask it with more pleasant sounds. Music or white noise could both work for this intervention. While you can’t wear headphones all the time, you may be able to wear them enough that your tinnitus becomes tolerable.

Stretching or Massage

Learning how to stretch your neck and the muscles around your jaw can help reduce tinnitus. This may be especially useful for tinnitus caused by muscle spasms, like MEM.

Surgery

For some types of tinnitus, including MEM, surgical options are available as a last resort. It may be possible to intervene with the muscles or tendons that are causing the problem such that they no longer pull on the bones of the ear, causing the annoying tapping sound. This has worked for people with MS and MEM before, though it hasn’t been studied enough to guarantee successful results.

Therapy

Sometimes, the annoying and frustrating sounds of tinnitus just won’t go away. In these cases, various forms of therapy can help you learn to manage the condition so it doesn’t negatively impact your mental health. Tinnitus retraining therapy helps you learn how to notice the tinnitus less frequently and feel less distressed when you do. Cognitive behavioral therapy can help you train your brain not to focus on the tinnitus as much.

If you suffer from anxiety or depression because of your tinnitus, counseling can help you come to terms with the condition and deal with any distress it causes.

Find Your Team

MyMSTeam is the social network for people living with MS and their loved ones. Here, more than 186,000 people come together to share their stories with MS, join ongoing conversations, and more. Soon, you’ll get to know a team of people from around the world who understand life with multiple sclerosis.

Do you struggle with tinnitus? Do you have other hearing problems related to MS? Share your story or thoughts in the comments below or by posting on MyMSTeam.