Tinnitus is common in fibromyalgia — small clinic studies put it at roughly a quarter to three-quarters of patients — and the most often proposed explanation, central sensitization (an amplified nervous system), remains a hypothesis rather than a proven pathway.
The article on somatic tinnitus covers how the nervous system can generate or amplify tinnitus through pathways beyond the ear itself. Fibromyalgia is one of the conditions most often discussed in that light, and the numbers behind it deserve a careful look.
How common the overlap is
Every tinnitus figure in this literature comes from a small sample of patients recruited through a clinic, not from a survey of the general population. That matters, because people attending a specialist clinic tend to have more severe illness, and the figures vary widely:
- Korea, 2021: 47 adults with fibromyalgia, recruited by advertisement at a single rheumatology clinic in 2020. 22 (46.8%) had tinnitus. The authors note that a tertiary-hospital sample may be more severely affected than fibromyalgia patients overall, and that they could not test the tinnitus group's hearing.
- Turkey, 2020: 101 women diagnosed with fibromyalgia, all given an ear, nose and throat examination and hearing tests. 74.3% had tinnitus.
- UK, 2021: 27 people with fibromyalgia compared with 26 healthy controls matched for age, sex and ethnicity. 59.3% of the patients had tinnitus, against 7.7% of the controls.
- United States, 2024: records from a paediatric rheumatology clinic, 2016 to 2021. Tinnitus was present in 31.1% of young people with juvenile fibromyalgia, against 3.5% of other patients seen at the same clinic.
- A 2024 narrative review of 17 papers found tinnitus rates ranging from 27.2% to 77.5% across the studies that measured it. The top of that range comes from the Japanese study described below, of 20 patients recruited because they had ear symptoms, so it describes people with ear complaints rather than fibromyalgia patients in general.
Two things hold across that range. The rates are high, and in the two studies with a comparison group the gap is large. What the evidence cannot yet give is a reliable figure for fibromyalgia as a whole, because no study here sampled the wider population of people living with it.
What hearing tests show
Hearing tests are often unremarkable. In the Turkish study, hearing test results were in the normal range, and a Japanese study of 20 patients with fibromyalgia and ear symptoms found no relationship between a feeling of ear fullness and abnormal findings on detailed ear testing — its authors suspected a central rather than an ear-based cause.
But a normal result is not the rule it is sometimes presented as. The 2024 review found that people with fibromyalgia had higher rates of hearing loss, mostly at high frequencies, as well as more hyperacusis, and that what patients reported did not always correspond to what tests found.
The explanation most studies propose is central sensitization: a state in which the central nervous system amplifies incoming signals generally, so that pain, sound, light and other input all register more strongly. A 2020 study of 50 people with fibromyalgia and 50 matched controls found higher activity in the prefrontal cortex in the fibromyalgia group and concluded that central sensitization may play a primary role in fibromyalgia pain. The review's authors link ear complaints in fibromyalgia to the same amplification. Tinnitus and the widespread pain of fibromyalgia may be two expressions of one process — a coherent hypothesis, not a demonstrated mechanism. Visual snow syndrome and tinnitus looks at a similar proposal.
Does severity track together?
Sometimes. In the Korean study, 20 of the 22 patients with tinnitus completed a tinnitus questionnaire: the 8 with moderate-to-severe tinnitus had worse fibromyalgia impact scores, physical functioning, social functioning and mental health than the 12 with mild tinnitus. The authors suggested tinnitus might act as an aggravating factor for fibromyalgia rather than a symptom riding along with it. With eight people in one group, that is a hypothesis worth testing rather than a finding. The same study found that having tinnitus at all, as opposed to how severe it was, was not associated with fibromyalgia severity.
The UK study found tinnitus handicap scores correlated with fibromyalgia impact scores (rs = 0.408), though that was measured across patients and controls together, so it partly reflects the difference between the two groups. The 2024 review sums up the wider literature: in some studies fibromyalgia severity was associated with ear symptoms, and in others it was not.
What the medication evidence shows
This is where the story most often gets ahead of the evidence.
In the Turkish study, the 101 women started routine fibromyalgia treatment with either pregabalin (a nerve-pain medicine) or duloxetine (an SNRI antidepressant). Two months later, tinnitus questionnaire scores had improved in both groups, with no difference between the drugs. There was no placebo or untreated group, so the improvement cannot be separated from tinnitus easing with time or with better-managed fibromyalgia, and the authors themselves concluded that further studies are needed before these drugs can be used for tinnitus.
The Korean study found something that points the other way: people with moderate-to-severe tinnitus were more likely to be taking an SSRI, SNRI or pregabalin (all 8, against 6 of the 12 with mild tinnitus). That is a cross-sectional snapshot and cannot say which came first, but it is not evidence that the medicines help. Drugs for tinnitus covers the wider evidence on medication for tinnitus itself.
What this means practically
- If you have fibromyalgia and tinnitus, a normal hearing test does not mean the tinnitus is imaginary or unrelated. Tinnitus with a normal audiogram is a recognised pattern in this group.
- Have a hearing test anyway. Hearing loss, mostly at high frequencies, is more common in fibromyalgia, and it is worth knowing about if it is there.
- Mention worsening tinnitus as part of your fibromyalgia care, not as a separate, unrelated complaint.
- Sound sensitivity is part of the same picture for many people. Hyperacusis and tinnitus covers what helps when ordinary sounds feel too loud.
- Fibromyalgia medicines may be worth discussing, as fibromyalgia treatments. The only tinnitus evidence for them is one uncontrolled study.
- CBT approaches, which address the distress that amplifies both conditions, are a reasonable complementary approach given the proposed shared mechanism.