Cannabis and Tinnitus in People With and Without HIV

In a large study of over 3,400 adults, researchers found no link between cannabis use and whether someone has tinnitus. However, among those who already experience tinnitus, using cannabis was associated with reporting it as less severe. This association was strongest in people without HIV.

How the Study Investigated Cannabis and Tinnitus

Researchers Chukwuemeka N. Okafor, Deanna Ware, and Andrew Edmonds analyzed data from the MACS/WIHS Combined Cohort Study (MWCCS), a long-running study focused on HIV. They used cross-sectional data from interviews conducted between October 2020 and September 2022.

The team defined tinnitus as “bothersome ringing, roaring, or buzzing in the ears or head” lasting at least five minutes in the past year. For participants who reported tinnitus, they split severity into two groups: no/small problem versus moderate to very big problem. Cannabis use was based on self-reported frequency over the previous six months.

The analysis used statistical models to estimate associations while accounting for multiple factors. These included age, sex, race/ethnicity, HIV status, loud noise exposure, self-rated hearing, smoking, and depression. For participants with HIV, the models also adjusted for viral load suppression and medication history.

Key Findings: Severity, Not Prevalence

The cohort of 3,437 participants had an average age of 55, was 55% female, and included 63% of people living with HIV. Sixteen percent reported bothersome tinnitus, and 31% reported using cannabis in the past six months.

The primary finding was clear: there was no statistically significant association between cannabis use and the likelihood of having tinnitus. Cannabis did not appear to influence whether the condition occurred.

The significant finding related to severity. Among participants who reported tinnitus, any cannabis use was associated with a 29% lower prevalence of rating their tinnitus as a moderate-to-very big problem. The adjusted prevalence ratio (aPR) was 0.71, with a 95% confidence interval of 0.54–0.94.

When the researchers looked at subgroups, the association held for people without HIV. In that group, cannabis use was linked to a 42% lower prevalence of moderate-to-severe tinnitus (aPR=0.58; 95% CI: 0.37–0.90). The association among people with HIV was not statistically significant. This suggests HIV status or related health factors may influence the relationship.

What Could Explain the Link to Lower Severity?

The authors state the underlying mechanisms are unclear. The study did not measure specific cannabinoids, methods of use, or dosages. The association with lower reported severity may not be directly due to a biological effect on the auditory system.

One hypothesis is that cannabis may alter the perception or emotional reaction to tinnitus. By potentially reducing anxiety or improving mood, cannabis might change how bothersome the internal sound feels, even if its acoustic signature remains. This connects to broader concepts in sound tolerance disorders, where the emotional and cognitive response to a sound is often the primary issue, as seen in research on misophonia and early maladaptive schemas.

Alternatively, people with more severe tinnitus might be less inclined to use cannabis, or other unmeasured lifestyle factors could explain the link. The cross-sectional design cannot determine cause and effect.

Practical Implications and Future Research

These findings are important for both patients and clinicians. For individuals with tinnitus who use cannabis or are considering it, this study offers a data point suggesting it might be associated with a lower subjective burden. However, it is not evidence that cannabis treats or cures tinnitus. The complex relationship between mental health and sound perception is critical; for example, managing conditions like depression is a known component of audiologist-led tinnitus management.

Given that poor sleep is a major aggravator of tinnitus severity, any substance affecting sleep architecture must be considered carefully. While this study did not examine sleep, readers interested in evidence-based sleep strategies can explore resources like an evidence-based sleep hygiene guide on our partner site.

The researchers emphasize their results are hypothesis-generating. They call for longitudinal studies that follow individuals over time to see if cannabis use precedes changes in tinnitus severity. Future work should also detail the type of cannabis used, as different compounds like THC and CBD may have opposing effects on perception and anxiety. Understanding the biological pathways will require integrating findings from various fields, including auditory neuroscience.

Source: Okafor, C. N., Ware, D., & Edmonds, A. (2024). Cannabis Use and Tinnitus in the MWCCS. Journal Title. DOI: 10.2174/0118746136457303260813073100.