Understanding the Connection Between POTS and Tinnitus

Understanding the Connection Between POTS and Tinnitus

Tinnitus and POTS (postural orthostatic tachycardia syndrome) are two complex chronic conditions that often coincide in the same patient. The ringing, buzzing, or other noises of tinnitus can be extremely bothersome, while the racing heart rate and dizziness of POTS can impact daily function. When experienced together, these symptoms can significantly reduce quality of life.

Research is still emerging on the link between POTS and tinnitus. But it's clear that individuals with POTS frequently report tinnitus symptoms. Understanding the relationship between these two conditions can help patients and doctors find better treatment approaches.

POTS Overview

POTS is a condition affecting blood flow and regulation of the autonomic nervous system. The main features include:

• Increase in heart rate of 30+ beats per minute when moving from sitting to standing (orthostatic tachycardia)
• Lightheadedness, dizziness, fainting
• Fatigue, exercise intolerance
• Cognitive dysfunction ("brain fog")
• Headache, nausea, abdominal pain
• Sleep disruptions

Symptoms are often worsened by activities that involve being upright like standing, walking and exercise. POTS predominantly impacts women between ages 15-50 years but can affect anyone.

Tinnitus Overview

Tinnitus refers to the perception of noise in one or both ears that has no external source. The sounds vary but are most commonly described as ringing, buzzing, humming, roaring or clicking.

Tinnitus can be constant or intermittent and the volume ranges from subtle to debilitating. It can develop suddenly or come on gradually over time.

Underlying causes include inner ear damage, age-related hearing loss, wax build-up, head/neck injuries, and circulatory system changes. But in many cases no specific cause is identified.

Statistics on POTS and Tinnitus

Studies investigating the prevalence of tinnitus specifically in POTS patients have found:

• 68% of patients with POTS reported tinnitus symptoms in one study.
• 78% of POTS patients experienced tinnitus in a second study.
• Greater tinnitus severity in POTS patients compared to controls.

Additionally, small studies on treating POTS have shown improvement in tinnitus symptoms along with dizziness and fatigue after increasing fluid intake, taking medication or wearing compression garments.

These preliminary findings demonstrate tinnitus consistently accompanies POTS. But more research is still needed on larger patient groups.

Possible Explanations for the Connection

Researchers have proposed several theories on why POTS and tinnitus overlap so frequently:

• Inner ear blood flow changes - Fluctuations in blood circulation caused by POTS may deprive the inner ear of consistent oxygenation leading to tinnitus.
• Trigeminal-autonomic reflex - This reflex links parts of the nervous system that control blood flow and the trigeminal nerve that connects to the ear. Dysfunction of the reflex in POTS patients may trigger tinnitus.
• Altered central nervous system processing - Sensory processing centers in the brain may be disrupted in POTS, causing erroneous auditory signals perceived as tinnitus.

POTS and tinnitus also share risk factors like being female, autoimmune conditions, vitamin deficiencies, thyroid disorders, head injuries, and neurodegenerative disease. These commonalities likely contribute to their overlap.

Tinnitus as a Symptom of POTS

For many POTS patients, tinnitus emerges either at the same time as their first symptoms or following their diagnosis. The tinnitus may initially come and go then become constant.

POTS episodes can acutely worsen tinnitus symptoms. Standing up typically triggers pounding heart rate and dizziness in POTS, and this can also amplify ringing or other sounds.

Lying back down and stabilizing blood pressure will often alleviate the tinnitus increase. But the underlying sounds frequently remain at a bothersome baseline level.

Impacts on Quality of Life

Experiencing tinnitus on top of the customary symptoms of POTS can seriously degrade quality of life in many ways:

• Sleep disturbances
• Difficulty concentrating affecting work/school performance
• Hearing difficulties
• Reduced social engagement
• Exacerbation of anxiety and depression
• Feelings of isolation

Coping strategies like sound therapy and cognitive behavioral therapy can help patients manage the impacts of tinnitus. But there is no cure for the disorder.

Treatment Options

Currently, no treatments specifically target tinnitus in POTS patients. But some pharmacological and lifestyle therapies to improve POTS symptoms may provide tinnitus relief as well.

First line options include:

• Increasing fluid intake - Staying well hydrated aids blood flow and prevents drops in blood pressure that can worsen tinnitus.
• Adding salt - Salt helps retain fluids and prevent low blood volume contributing to POTS episodes.
• Wearing compression garments - Compression stockings or abdominal binders improve venous blood return to the heart and stabilize symptoms.

Medications that may lessen tinnitus along with POTS include:

• Beta blockers like propranolol
• Blood pressure medications
• SSRIs for anxiety/depression
• Sedatives for sleep difficulties

For severe and debilitating tinnitus, highly customized sound therapy using an ear-worn device can help neutralize or mask the distracting noises.

The Importance of Salt and Fluids

Adequate salt and fluid intake is essential for managing POTS and related conditions like tinnitus. Here's why:

• Helps maintain sufficient blood volume so the heart can pump efficiently
• Prevents drops in blood pressure that trigger symptoms
• Improves orthostatic tolerance for standing/activity
• Stabilizes blood flow to the ears
• Reduces workload on the heart

Patients are often advised to drink 2-3 liters of fluids daily and consume 10-12 grams of salt from food, fluids and supplements. This requires a conscious daily effort.

The Importance of Physical Therapy

Working with a knowledgeable physical therapist can be instrumental for POTS patients. Goals of PT include:

• Gradually increasing activity tolerance through reconditioning exercises
• Learning exercises to strengthen muscles and improve circulation
• Establishing individualized exercise routines
• Adapting movements to avoid triggering symptoms
• Learning effective compression garment use

Improving fitness through PT gives POTS patients stamina, confidence and control over their symptoms long-term.

Dealing With Fluctuating Tinnitus

POTS and tinnitus have a complex relationship, with changes in one condition impacting the other. Patients can experience significant fluctuations in their tinnitus volume and severity on a daily or even hourly basis.

Monitoring your tinnitus patterns in relation to your POTS episodes, along with diet, sleep, activities and stress can help you identify triggers to avoid. This takes diligence but allows you to minimize spikes.

Counseling also equips patients with coping methods to deal with tinnitus surges without becoming despondent. Having strategies to get through difficult periods reduces suffering.

Hope for the Future

Research into POTS and its related conditions like tinnitus is a rapidly evolving field. Growing awareness of POTS as a medical disorder is bringing more attention to its overlapping symptoms like tinnitus.

As experts gain insight into the mechanisms behind POTS and tinnitus through further study, more tailored and multi-modal treatment approaches will hopefully emerge to provide greater symptom relief.

POTS currently has no cure. But the outlook for managing symptoms long-term continues to improve, providing hope for patients.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.