Does coffee make tinnitus worse? I quit for six weeks to find out

The first pamphlet I ever got about tinnitus had a list of things to avoid, and coffee was near the top, right under loud noise. So in the winter of 2018 I quit. Cold turkey, which on a railroad schedule is a special kind of misery.

For six weeks I drank decaf and herbal tea. I had a headache for the first four days and was short with my wife for about ten. The ringing didn't change at all. Same hiss, same whistle at night. When I went back to my two big mugs in the morning, it didn't get louder either.

One man's experiment proves nothing, so I went looking for real studies. There are two worth knowing about, and they surprised me.

The big one: 65,000 nurses, 18 years

In 2014 a team from Harvard and Western University in Ontario looked at women in the Nurses' Health Study II, a long-running study that sends questionnaires every couple of years. They followed 65,085 women who had no tinnitus at the start, in 1991, when they were 30 to 44 years old. By 2009, 5,289 of them had developed tinnitus.

The researchers compared how much caffeine each woman drank with whether she later got tinnitus. The finding ran the opposite way from my pamphlet: the women who drank the most caffeine were less likely to develop it.

A hazard ratio of 0.79 means about 21% lower risk over the follow-up. The researchers adjusted for a long list of other factors before reporting it, so it isn't just that coffee drinkers were younger or healthier to begin with, at least not in any way they could measure.

Before anyone starts drinking six cups a day on my say-so, a few cautions:

• This was women only, all of them nurses. Whether it holds for men isn't known from this study.
• It's observational. It shows a link, not that caffeine prevents tinnitus. People who feel fine may simply drink more coffee.
• Tinnitus was self-reported on a questionnaire, which is how most tinnitus research works, but it's still a loose measure.

What it does show is that a lifetime of coffee isn't clearly making ears ring. That alone would have saved me six weeks of headaches.

What happens when people with tinnitus quit

The nurses study looked at people who didn't have tinnitus yet. I wanted to know about people like me who already had it. A team at the University of Bristol tested exactly that.

They took 66 people with tinnitus who drank at least 150 mg of caffeine a day and quietly swapped their usual tea and coffee for supplies that were either caffeinated or decaf. Neither the volunteers nor the researchers knew which was which. Over 30 days, people went through a phased withdrawal at different points.

Caffeine made no measurable difference to how bad their tinnitus was. The gap between caffeinated and decaf days was essentially zero. What the study did find was the usual withdrawal mess: headaches, tiredness, low mood. The authors titled the paper "Caffeine abstinence: an ineffective and potentially distressing tinnitus therapy," which is about as blunt as a journal gets.

That matched my winter of decaf almost exactly. And I think it explains why so many people swear coffee makes their ringing worse. Skip your usual cup, get the headache and the foggy, irritable afternoon that come with withdrawal, and of course the ringing seems louder. You're in a worse mood and you're listening for it. Have the cup, feel human again, and the ringing fades back. It's easy to blame the ear for what the rest of you is feeling.

How much caffeine is in what you drink

If you do want to keep an eye on it, it helps to know where the caffeine actually is. These are the FDA's typical figures for a 12-ounce serving, which is a regular mug or a can.

The FDA's caffeine guidance says that for most healthy adults, 400 mg a day isn't generally linked with problems. That's two or three big mugs of brewed coffee. My two mugs land around 300 to 400 mg on a strong day, so I'm near the top of that range and I've decided I'm fine with it.

Where caffeine can still bite

There's one way caffeine does make my tinnitus worse, and it's indirect. If I drink coffee after about two in the afternoon, I sleep badly. If I sleep badly, the ringing is the first thing I notice in the morning and it bugs me all day. The ear hasn't changed. My patience has.

So my rule now is about timing, not quantity: all the caffeine before lunch, nothing after. That includes the sneaky sources. Pain relievers with caffeine, some cold medicines, chocolate after dinner, and a few supplements.

On that last point, some hearing supplements carry caffeine too, which surprised me. Audifort, a liquid hearing formula that a guy at the union hall asked me about, lists guarana and green tea in its blend. Both bring caffeine. The page on side effects of the Audifort drops explains why that makes it a morning product, which is the same rule I'd follow for coffee.

What I'd tell someone who just started ringing

Don't quit coffee because a pamphlet told you to. If you want to test it on yourself, do it properly: taper over a week or two rather than stopping cold, keep a simple log of how loud the ringing seems each morning on a 1 to 10 scale, and give it at least a month before deciding anything. Then go back to your normal intake and log another month.

Most people, if the research is right, will see no difference. A few might. Either way you'll know, instead of guessing.

The reading I found most useful on this, with more of the background on why caffeine got blamed in the first place, is a longer walk through the caffeine and tinnitus research on a hearing site I check now and then.

My log, for what it's worth

One man's numbers, scored by the same tired man every morning, so take them for what they are. The only change that moved anything was sleep. That's the subject of a separate piece here, because it ended up mattering more than anything I put in my mouth.