Medicines used to treat other diseases, as well as foods and other ingested materials, can result in unwanted tinnitus. These include alcohol, antineoplastic chemotherapeutic agents and heavy metals, antimetabolites, antitumor agents, antibiotics, caffeine, cocaine, marijuana, nonnarcotic analgesics and antipyretics, ototoxic antibiotics and diuretics, oral contraceptives, quinine and chloroquine, and salicylates.

References: Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG. Review of Pharmacotherapy for Tinnitus. Healthcare (Basel). 2021 Jun 21;9(6):779. doi: 10.3390/healthcare9060779. PMID: 34205776; PMCID: PMC8235102.

Patients with impacted ear wax that occludes the external auditory canal can present with tinnitus, conductive hearing loss and aural fullness. Symptoms usually resolve with clearance of the wax.

References: Chan HBY, Low D, Yuen HW, How CH. Tinnitus – ringing in the ears. Singapore Med J. 2020 Sep;61(9):448-452. doi: 10.11622/smedj.2020128. PMID: 33043372; PMCID: PMC7927175.

The hypothalamus pituitary adrenal axis, one of the main neuroendocrine systems involved in stress response, is commonly disturbed in tinnitus patients. Patients with chronic tinnitus have been shown to develop abnormal responses to psycho-social stress, where the hypothalamus pituitary adrenal axis response is weaker and delayed, suggesting chronic stress contributes to the development of chronic tinnitus.

References: Patil JD, Alrashid MA, Eltabbakh A, Fredericks S. The association between stress, emotional states, and tinnitus: a mini-review. Front Aging Neurosci. 2023 May 3;15:1131979. doi: 10.3389/fnagi.2023.1131979. PMID: 37207076; PMCID: PMC10188965.