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

Tinnitus can be frustrating and can even affect your mental health or quality of life. Understanding how tinnitus is related to MS can help you and your doctor find a treatment plan that works for you.

What Is Tinnitus Like With MS?

MyMSTeam members have talked about their tinnitus. “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!”

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 be bothersome and frustrating.

What Causes Tinnitus in MS?

Health experts believe that tinnitus in people with MS may be linked to lesions affecting hearing pathways. But other potential causes should be checked as well.

In people with MS, lesions are caused by demyelination, the destruction of the myelin sheath surrounding nerves. A person’s autoimmune system wears away at this fatty protective sheathing, damaging the auditory nerve, brainstem, or auditory pathways. These lesions cause nerve damage that can disrupt the electrical messages sent from the nerves to the brain, which can result in tinnitus.

Middle Ear Myoclonus

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

In MEM, muscles in the middle ear contract repeatedly, which creates a clicking sound. 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 or relapse. If you’re experiencing these types of symptoms for the first time, contact your neurologist. Your healthcare 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 (especially inner ear infection)
• A blockage in the ear, like excessive earwax
• Close exposure to very loud noise, like an explosion or excessively loud music
• Hearing loss that has damaged the cilia (small hairs inside the ear)
• Certain medications (taken for conditions other than MS)
• Trauma or injury to the head or neck

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

Managing Tinnitus With MS

There are several tinnitus treatment options available. Some treatments are specific to certain causes, while others can help relieve tinnitus regardless of its origin.

Underlying Cause Treatment

If your tinnitus is caused by an underlying condition other than MS, then treating 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

Medication

There are several medications available that help with tinnitus.

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

Researchers have found success with several medications, including alprazolam, amitriptyline, clonazepam, nortriptyline, and oxazepam, that may be prescribed to treat tinnitus and other symptoms.

These medications may also treat anxiety, depression, or sleep problems related to tinnitus, or in rare cases, MEM. Their use should be discussed with a doctor because they can cause side effects and may interact with MS medications.

It’s also important to know that none of these medications are FDA-approved specifically to treat tinnitus. They are prescribed based on clinical judgment and available evidence.

Sound Therapy

Sound therapy uses naturally occurring sounds to help suppress tinnitus. 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

Stretching and massaging 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 so that they no longer pull on the ear, causing the annoying tapping sound.

Therapy

Sometimes, the annoying and frustrating sounds of tinnitus just won’t go away. In these cases, various forms of therapy may 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 bothered when you do. Cognitive behavioral therapy can help you train your brain not to focus on the tinnitus as much.

If you experience anxiety or depression because of your tinnitus, counseling can help you adjust to the condition and manage any discomfort it causes.