Why Do Tinnitus and Allergies Occur Together?
Tinnitus and allergies often appear together—but why? The connection usually comes down to two underlying mechanisms: Eustachian tube dysfunction and atypical migraine. Most doctors are familiar with the first, but far fewer recognize the role migraine-like inflammation can play in amplifying tinnitus.
In this article, we’ll explore how allergy symptoms like sinus pressure, nasal congestion, or ear fullness can make tinnitus worse—and why those symptoms may sometimes reflect a neurological process, not just an allergic one.
- Can allergies cause tinnitus?
- Can Eustachian tube dysfunction cause tinnitus?
- What is aural fullness?
- The Migraine Link Between Allergies and Ear Ringing
- Best Treatments for Allergy-Related Tinnitus
Can allergies cause tinnitus?
Technically speaking, allergies don’t cause your ears to ring; rather, they can cause pre-existing ear ringing to seem louder. Allergies can amplify the perception of tinnitus via Eustachian tube issues. Alternatively, apparent allergy symptoms (congestion, ear fullness and sinus headaches) and tinnitus, when they occur together, may actually be the manifestation of an atypical migraine process.
When you get clogged ears from an allergic reaction or when the migraine process is active in your brain, allergies and tinnitus become associated. In these cases, it's not truly “allergy-induced tinnitus”; rather, its “allergy associated tinnitus”.
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Can allergy symptoms cause ear buzzing tinnitus?
Buzzing tinnitus and ringing tinnitus are both forms of the same process. The difference is that buzzing tinnitus is usually associated with low frequency hearing loss, whereas ringing tinnitus is associated with high frequency hearing loss.
Again, allergies and ear buzzing can be related through either Eustachian tube dysfunction or the migraine process in the brain. When buzzing tinnitus fluctuates with allergy severity and the eardrums are working properly, there’s a good chance that the migraine process is responsible.
Can Eustachian tube dysfunction cause tinnitus?
Allergic rhinitis and tinnitus may be associated through Eustachian tube dysfunction (ETD), which itself can cause tinnitus sounds to seem louder. In this sense, allergies cause tinnitus indirectly. Importantly, if this is the cause of tinnitus, it should reverse once the Eustachian tube is cleared up. If this is not the case, a migraine-related process may be responsible for the tinnitus.
What is the Eustachian tube?
The Eustachian tubes are small tubes that connect the space behind the eardrum (middle ear) with the back of the nasal passages. Their primary function is to equalize pressure in the middle ear and drain fluids from behind the eardrum. The tubes are normally closed but open once every few minutes when you swallow or yawn and equalize the pressure behind the eardrum.
What causes Eustachian tube dysfunction?
There are multiple causes, but allergic rhinitis is a common one. When your allergy symptoms are active (from hay fever, food allergies, or seasonal allergies), inflammation and congestion in the nasal passages can extend to the tubes, causing them to become blocked. So when you yawn or swallow, the tubes don’t open and the pressure behind the eardrum and the outside air pressure are different.
Does Eustachian Tube Dysfunction Cause Hearing Loss?
The pressure issues from dysfunctional Eustachian tubes causes the eardrum (tympanic membrane) to get pulled inward and get stretched. When the eardrum gets stretched, it doesn’t vibrate as well and it causes a temporary hearing loss (called conductive hearing loss). This is when hearing is impaired because of problems with the ear canal (external ear), ear drum, or bone bones of hearing (middle ear).
Why Does Hearing Loss Make Tinnitus Seem Louder?
This is because when the ears are plugged, your internal sounds become louder. Try it yourself! Put your fingers in your ears and say something. You’ll notice that your voice sounds louder when your ears are plugged. When dysfunctional Eustachian tubes cause reduced hearing from poor conduction, it worsens tinnitus because the tinnitus sounds in the brain sounds seem louder.
Does congestion cause tinnitus?
Nasal congestion from any cause can worsen tinnitus, whether from allergy symptoms, chronic sinus infections, excess mucus, or runny nose from a virus (e.g., a cold or COVID). The mucus buildup from nasal congestion can block the Eustachian tube. As described above, this leads to a slight hearing loss, which in turn amplifies internal sounds like tinnitus.
When severe, nasal congestion can also cause fluid to build up in the middle ear, making the conductive hearing loss even worse. Chronic mucus buildup can lead to ear infections. That's why with sinus infections and ear infections, the tinnitus can seem worse. It can also sometimes lead to pulsatile tinnitus, when you hear the pulsing of your heart in your ears.
What are the symptoms of Eustachian tube problems?
Clogged ears and allergy symptoms can present in various ways, including:
- Ear Fullness: A sensation of fullness or pressure in the ears.
- Hearing Changes: Fluctuations in hearing, muffled sounds, or difficulty hearing.
- Ear Popping or Crackling: Clicking or popping sounds in the ears.
- Discomfort or Pain: Mild to moderate ear pain or discomfort.
- Dizziness: Some individuals may experience a sense of imbalance or dizziness.
- Difficulty Equalizing Pressure: Challenges equalizing ear pressure, especially in abnormal pressure changes, such as when flying.
However, the feeling of “clogged ears” may not be Eustachian tube dysfunction. Instead, it may represent a condition called “aural fullness”.
What is aural fullness?
Aural fullness refers to a sensation of fullness or pressure in the ears, often described as feeling like the ears are blocked or clogged. This may feel exactly like an allergy response, but the eardrum may be working perfectly. Medications that relieve allergy symptoms may fail to work on aural fullness.
Conditions associated with aural fullness are Meniere's disease, idiopathic sudden sensorineural hearing loss, temporomandibular disorders, tinnitus, and migraine. Around 30% of people with tinnitus experience aural fullness, and in 70% of these, the eardrums work fine.
How Migraine Triggers Aural Fullness and Tinnitus
My research team pioneered the work that outlines the connection between migraine and aural fullness [1]. The eardrum is innervated by the trigeminal nerve, the same nerve that is activated in migraine. Many patients in our clinical study on the aural fullness-migraine connection were ones who had been unsuccessfully treated for allergic rhinitis and Eustachian tube dysfunction. When we treated them with a modified migraine protocol, there were statistically significant improvements in aural fullness [2].
How Doctors Test for Aural Fullness (vs. Eustachian Tube Dysfunction)
An ENT doctor or audiologist can do a test called a tympanogram (an ear drum test) which can quickly and accurately diagnose how well the eustachian tube is working. A normal tympanogram and ear exam with a sensation of clogged ears may represent aural fullness rather than ear pressure problems. This likely means that a migraine-like process may be what's going on.
The Migraine Link Between Allergies and Ear Ringing
Allergy symptoms have also been linked to migraine, a condition where there is hypersensitivity and inflammation in the brain. Here, it’s important to understand the interconnected relationship between migraine, allergies and ear ringing.
Can Migraine Cause Tinnitus?
There are many kinds of migraine that do not involve headaches. Recent research suggests that tinnitus may be related to a migraine-like process in the brain. In fact, migraine is being reclassified as a sensory processing disorder that's triggered by brain inflammation. The sensory hypersensitivity of migraine causes increased attention to the tinnitus sound in the brain.
Are Migraines Triggered by Allergies?
Numerous clinical studies have documented that migraines and allergic rhinitis frequently appear together in the same person. Further, both conditions share common elements, such as inflammation and histamine reactivity. Migraine attacks also seem to increase during allergy season. Finally, people with allergies often mistake associated migraine symptoms as being “sinus headaches” (see below).
Are “Sinus Headaches” Actually Migraines?
“Sinus headache” is the most common misdiagnosis of migraine. We now know that the vast majority of “sinus headaches” without acute nasal inflammation are actually due to migraines [3]. It's estimated that over 80% of migraine patients had a prior diagnosis of a sinus headache and around 95% of these had unnecessary antibiotic treatment. An additional portion had unnecessary sinus surgery before being diagnosed with migraine. People with allergies and tinnitus need to be aware of this, as typical allergy symptoms can sometimes be migraine in disguise.
How Migraine Connects Allergies and Tinnitus
It’s possible, therefore, that allergies and tinnitus are related through a shared migraine response in the brain. Here, you can't say “allergies cause tinnitus”; rather, the symptoms of allergies and tinnitus are both manifestations of the same migraine-like reaction in the brain.
If you still have persistent tinnitus after your allergies are under control, the tinnitus may be migraine related. In these cases, tinnitus caused by migraine will likely not respond to allergy medications (such as nasal corticosteroids or antihistamines). This is because the problem is not in the inner or middle ear; the underlying cause is the migraine process in the brain.
Best Treatments for Allergy-Related Tinnitus
The best treatment options managing allergies and tinnitus is to first be sure of the cause; is it allergies and Eustachian tube dysfunction or is it the migraine process? Effective ways to treat allergy-associated tinnitus will depend on the answer to this question.
Allergy Management: If you've determined that allergies are causing the tinnitus, you should start to identify and avoid allergens whenever possible and use allergy medication or immunotherapy to relieve congestion. The best allergy medicine for tinnitus is probably nasal corticosteroids like Flonase. If this fails to relieve your allergic rhinitis, consulting with an allergist to evaluate your immune system may be appropriate, especially if you have asthma, sinus infections, or recurrent ear infections. You should also start to suspect a migraine-like process as the culprit for the tinnitus, rather than allergies.
Eustachian Tube Treatment: First, determine if you have Eustachian tube dysfunction rather than “aural fullness”. This may require a physical exam with an ENT or a tympanogram test. If Eustachian tube problems are confirmed, you can try techniques nasal decongestants, nasal corticosteroids, or eustachian tube exercises. Home remedies like chewing gum or yawning may help the tubes to open. In severe cases, an ENT specialist may recommend the placement of ear tubes or a ballon dilation procedure. However, if your eardrums are working fine according to your ENT, it may represent aural fullness and migraine.
Migraine Management: If your tinnitus symptoms do not respond to typical allergy treatment, you should suspect a migraine-like process is to blame. You can adopt migraine management strategies, including certain medications, adequate sleep, hydration, and dietary changes. This strategy is most appropriate for those who have normal functioning eustachian tubes, an indication that the migraine process is behind the tinnitus and allergies. Remember, aural fullness can look exactly like Eustachian tube dysfunction. It will not respond to allergy treatment, but it will respond to migraine treatment.
Integrative Medicine Interventions: Work with a healthcare provider skilled in integrative medicine to address underlying health imbalances contributing to allergy-induced tinnitus, such as inflammation, hormonal imbalances, or nutritional deficiencies.
Conclusion: Allergies and Tinnitus? It Might Be Migraine
A comprehensive approach to managing allergies and tinnitus can provide significant relief from ear ringing and enhance overall quality of life. For tinnitus symptoms that come with Eustachian tube problems, treatment options include over-the-counter medications to relieve congestion or the runny nose of allergic rhinitis. This should help any Eustachian tube issues and reduce tinnitus.
In cases that don't respond to allergy medications, you must ask, ‘Is this allergy-related tinnitus? or is it the aural fullness and sinus headache of migraine?'. If the underlying cause is a migraine process is involved, adopting treatment options that include migraine interventions may be needed.
If you suspect your symptoms are migraine-related, the NeuroMed program is designed to provide lasting relief. Schedule a FREE consultation today to explore your options!
Allergies and Tinnitus: Frequently Asked Questions
Can allergies cause ear pain?
Yes, allergies can cause ear pain—though not in the way most people expect. The pain typically results from inflammation in the nasal passages that spreads to the Eustachian tubes. This creates pressure imbalances that pull the eardrum inward, leading to discomfort. The pain isn’t usually sharp, but more of a dull ache or sense of fullness. This is why ear pain with allergies often feels worse during altitude changes or when swallowing.
How are allergies and clogged ears related?
Allergies and clogged ears are linked through Eustachian tube dysfunction. These small tubes connect your middle ear to the back of your throat. When swollen due to allergic rhinitis or seasonal triggers, they can't equalize pressure correctly, leading to that classic “clogged ear” sensation. If it lingers, it may cause mild hearing loss or contribute to amplified tinnitus perception.
Can allergies cause ear infections?
While allergies don’t directly cause infections, they can set the stage for one. Allergic inflammation can lead to fluid buildup in the middle ear. If that fluid sits too long, it can become infected—especially in people prone to sinus infections or who have chronic congestion. So while not the root cause, allergies often play a supporting role in recurring ear infections.
What do blocked ears allergies feel like?
Blocked ears from allergies feel like pressure or fullness, almost as if you're underwater. This happens because allergic congestion blocks the Eustachian tube, trapping air or fluid behind the eardrum. It’s not uncommon for people to experience muffled hearing or popping sounds. And if you already have tinnitus, the blocked sensation can make the ringing seem louder.
What causes ear pain allergies and sinus issues to overlap?
Ear pain allergies and sinus congestion go hand in hand because they both involve inflammation of the upper airway. When your sinuses are blocked, it can cause pressure behind your ears—especially if your Eustachian tubes aren’t functioning well. This pressure not only causes ear discomfort, but it may also make tinnitus louder due to a temporary decrease in hearing clarity.
What is the connection between allergies and ear pain?
Allergies and ear pain often stem from the same source: inflammation that leads to Eustachian tube dysfunction. When the pressure can’t equalize between your middle ear and the outside environment, it stretches the eardrum. This causes discomfort or aching, especially during allergy flare-ups, flights, or elevation changes. Sometimes, this pain is mistakenly diagnosed as an ear infection.
What is allergies ear pain and how is it different from an ear infection?
Allergies ear pain typically develops gradually and fluctuates with your allergy symptoms—getting worse with congestion and improving with decongestants. Unlike an ear infection, which usually causes fever or sharp, constant pain, allergy-related ear pain feels more like pressure or muffled hearing. It’s often one of the first signs that your sinuses or Eustachian tubes are inflamed.
What are common ear allergy symptoms?
Ear allergy symptoms include clogged or full ears, muffled hearing, popping sensations, mild earache, or increased tinnitus volume. These symptoms tend to fluctuate with allergy triggers like pollen, dust, or food sensitivity. If your ears feel blocked but your ENT says your eardrum looks normal, it may be a sign of a migraine-like process rather than simple allergies.
Can allergies affect your ears even if your nose isn’t stuffed?
Yes. Even without obvious nasal congestion, allergic inflammation can silently affect the Eustachian tubes. That means you might feel ear pressure, pain, or ringing without a runny nose. For some patients, this can also show up as aural fullness—especially when the issue is neurological (migraine-related) rather than structural.
What’s the link between allergies and ear pressure?
Allergies and ear pressure are most commonly linked to Eustachian tube dysfunction, where inflammation from allergic rhinitis prevents the tubes from opening properly. This creates a pressure imbalance in the middle ear, which can feel like fullness, cause muffled hearing, or lead to dizziness. But if your ear exam is normal and pressure still persists, the sensation may actually be aural fullness—a symptom often mistaken for allergies but frequently tied to migraine-related nerve hypersensitivity, not congestion.
Tinnitus and Allergies References
[1] Risbud A, Muhonen EG, Tsutsumi K, Martin EC, Abouzari M, Djalilian HR. Migraine Features in Patients With Isolated Aural Fullness and Proposal for a New Diagnosis. Otol Neurotol. 2021 Dec 1;42(10):1580-1584.
[2] Moshtaghi O, Ghavami Y, Mahboubi H, Sahyouni R, Haidar Y, Ziai K, Lin HW, Djalilian HR. Migraine-Related Aural Fullness: A Potential Clinical Entity. Otolaryngol Head Neck Surg. 2018 Jan;158(1):100-102.
[3] Straburzyński M, Gryglas-Dworak A, Nowaczewska M, Brożek-Mądry E, Martelletti P. Etiology of ‘Sinus Headache'-Moving the Focus from Rhinology to Neurology. A Systematic Review. Brain Sci. 2021 Jan 9;11(1):79.
