What is Tinnitus in Withdrawal? Benzodiazepine Glossary

1. What is Tinnitus in Withdrawal?

Tinnitus in benzodiazepine withdrawal is a ringing, buzzing, hissing, or roaring sound in one or both ears that appears or worsens during dose reduction or after stopping benzodiazepines, as part of the benzodiazepine withdrawal syndrome.[1][3] It is considered an infrequent but potentially distressing and sometimes long‑lasting withdrawal symptom.[1][3][4]

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2. Why it happens (Mechanism)

Benzodiazepines enhance the effect of GABA, the main inhibitory (calming) neurotransmitter in the brain.[1][3]
With long‑term use, the nervous system adapts, becoming relatively over‑excitable when the drug is reduced or stopped.[1][3]

During withdrawal:

• Loss of GABAergic calming input leads to central nervous system hyperexcitability, including in the auditory pathways and auditory cortex.[1][3]
• This hyperactivity and abnormal neural firing in auditory circuits are thought to generate the perception of sound without an external source (tinnitus).[1][2]
• Clinical reports show tinnitus can start when doses are cut (for example, at 50% of a long‑term clonazepam or diazepam dose) and may briefly improve if the benzodiazepine is reinstated, which supports a withdrawal‑related mechanism.[1][3]

Overall, tinnitus in withdrawal appears to reflect neurochemical imbalance and heightened sensory sensitivity while the brain is re‑adapting after benzodiazepine exposure.[1][3][6]

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3. How long it lasts

Duration is highly variable:

• Many withdrawal symptoms, including tinnitus, improve over weeks to a few months after tapering, especially with gradual dose reductions.[1][2][3]
• Case series and observational studies report tinnitus often lessens over time, with some patients recovering within 6–12 months after discontinuation.[1][2]
• In one report, tinnitus decreased by 6 months and resolved by 1 year.[1]
• Some individuals experience protracted withdrawal, in which tinnitus and other symptoms can persist for many months or, in a minority, years, though this is less common.[3][6][7]

Most medical sources describe benzodiazepine‑withdrawal tinnitus as rare and usually not permanent, but acknowledge it can be long‑lasting in some cases.[2][3][4][7]

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4. How to cope

Management should be individualized and done with professional guidance:

• Work with a prescriber on tapering

  • Use a slow, personalized taper (often 5–10% dose reductions at intervals) to reduce withdrawal intensity, including tinnitus.[1][2][4]
  • Avoid abrupt stopping, which increases risk of severe symptoms.[1][3][4]

• Medical evaluation

  • See a clinician or audiologist to rule out other causes of tinnitus (ear disease, noise exposure, other ototoxic drugs) and to document hearing status.[1][2][4]

• Sound and hearing strategies

  • Use background sound (fans, soft music, white‑noise or tinnitus maskers) to make tinnitus less noticeable, especially at night.
  • Consider hearing aids or sound therapy if hearing loss or significant tinnitus‑related distress is present, under audiology guidance.[2]

• Stress and sleep management

  • Practice relaxation techniques (breathing exercises, mindfulness, gentle stretching) to lower overall arousal, which often worsens tinnitus perception.[2][6]
  • Maintain regular sleep routines; address insomnia with non‑drug strategies (sleep hygiene, cognitive‑behavioral approaches).

• Psychological support

  • Cognitive‑behavioral therapy (CBT) for tinnitus or for anxiety can reduce distress and improve coping even if loudness does not change.[2][5]
  • Support groups or counseling for benzodiazepine withdrawal can help with expectations and coping strategies.[6][7]

• Medication decisions

  • Re‑starting a benzodiazepine may temporarily relieve withdrawal tinnitus in some cases, but it carries the risk of prolonging dependence and is not a long‑term solution.[1][3][5]
  • Other drugs (including some used for anxiety, depression, or pain) can themselves affect tinnitus, so any new medication should be reviewed with a clinician.[4][5]

If tinnitus is sudden, one‑sided, associated with hearing loss, vertigo, or neurological symptoms, urgent evaluation is needed to rule out other conditions.