Can DMT Cause Tinnitus

On the subreddit r/DMT, there are many posts from users who describe developing tinnitus after using DMT. This wasn’t a potential risk of DMT – or any psychedelic – I had considered. Admittedly, the link between DMT use and tinnitus is mostly anecdotal at this point. Still, the number of DMT users reporting newly developed tinnitus, or worsened tinnitus, after using the compound can, understandably, make one wonder whether this outcome is something one should be concerned about. These reports also raise the question of whether DMT causes tinnitus or if it is correlated with it in other ways, e.g. by making existing tinnitus more noticeable. Tinnitus may also occur alongside DMT use but be unrelated to it.

If DMT (and other psychedelics) can cause or worsen tinnitus, this would be a risk of psychedelic use worth exploring scientifically, including the mechanisms involved and the factors that can prevent or treat psychedelic-related tinnitus. Research might also uncover if (and why) DMT, in particular, is prone to cause or worsen tinnitus. (It’s worth noting that the onset of a DMT trip often features what’s called the ‘carrier wave’, a high-pitched ringing or buzzing sound that increases in intensity, in sync with the increasing intensity of the visual effects. However, it is not clear if this effect is at all related to the higher incidence of tinnitus induced by DMT compared to other psychedelics.)

Let’s take a look at some of the reports from r/DMT regarding DMT use and tinnitus. The Redditor u/Ubc56950 writes in a post:

All the evidence is anecdotal, as is almost everything related to DMT, but it seems clear that there is a significant risk of developing long term/permanent auditory hallucinations even after a single trip. Every time someone posts about it, the comments fill with nonsense about "you're just tuned to a higher frequency now" or "that is a sacred sound". Tinnitus is serious and can ruin your life. I don't know why it's almost never mentioned as a real risk associated with DMT.

• “There was one point that dmt made it much worse for about a month but then it returned to baseline.”
• “[E]ars still ringing here after like maybe 14 months.”
• “[I] hear a permanent biiiiiiiiiiiip sound forever now.”
• “I don't just think it's only dmt though. My experience has been from prolonged LSD and weed use without giving my brain a rest.”
• “Yup happened to me after mushrooms and a girl I know after acid.”

However, just as one can find anecdotes of DMT triggering or exacerbating tinnitus, there are also accounts of people finding it reduced their tinnitus symptoms. Some Redditors even claim that DMT cured their tinnitus. Here are some reports:

• “DMT makes my tinnitus go away almost completely.”
• “Had tinnitus for years, dmt “cured” it.”
• “My last trip I took LSD and smoked DMT at mid point. My tinnitus disappeared and was best it's been for like 2 weeks then returned gradually.”
• “DMT made mine better. Have had it bad ever since Iraq.”

In any case, online reports – from Reddit and forums like DMT Nexus – show a range of different tinnitus-related reactions to DMT. One can find the following: cases of tinnitus when none was noticed before, worsened symptoms, reduced symptoms, the eradication of symptoms, and negative or beneficial effects that are short-term, medium-term, or long-term.

For most users who notice tinnitus after DMT, symptoms usually pass on their own, after cessation of DMT use. However, even if we go in-depth into these reports, we cannot ascertain the true prevalence of DMT-induced tinnitus (or improved tinnitus after DMT), nor how long symptoms (or improvements) persist for most people. We also don’t know the factors that most strongly predict these sorts of changes, how significant they are, or how long they last.

DMT clinical trials haven’t reported tinnitus as a side effect, so it could either be very rare, or we just don’t have enough clinical trials to show it’s a possible side effect of the compound. So far, the research on this link is extremely limited. We have a 2021 case report published in the Journal of Psychoactive Drugs, which examined a case of persistent tinnitus in someone after they used DMT. However, there were complicating factors involved. As the abstract states:

This case report describes a 39-year-old male with remote history of polysubstance use disorder and depression who developed tinnitus after use of inhaled N,N-dimethyltryptamine (DMT). Although development of ear ringing was attributed to use on a single occasion, tinnitus occurred within the context of a larger self-experiment involving weekly microdoses of lysergic acid diethylamide (LSD). Distress and anxiety over the ear ringing prompted evaluation by an audiologist, primary care physician, and consultant psychopharmacologist. Tinnitus persisted for several months, although intensity and ability to cope with symptoms improved over time. A microdose of psilocybin mushrooms exacerbated tinnitus on two separate occasions, after which psychedelics were discontinued. Psychedelics are associated with a range of acute sensory changes including auditory phenomenon, although have not previously been associated with tinnitus in medical literature.

Tinnitus has been experienced by those drinking ayahuasca (orally active DMT) as well. A 2020 Brazilian study on the risks of ayahuasca use in a religious context found that tinnitus was a common effect (emerging during the experience), but as a persistent effect, it was rare (occurring in 3.75% of study participants).

Rather than DMT causing tinnitus when none previously existed, most cases of DMT-related tinnitus may involve a worsening of existing symptoms. Tinnitus is quite common, but symptoms exist on a spectrum. Since most DMT users are young, and therefore less likely to have severe tinnitus – given that it’s often age-related or emerges most noticeably after years of exposure to loud noises – newly noticed tinnitus may be a worsening of mild symptoms. These symptoms could be barely noticeable or unnoticeable. But they might louden or intrude into one’s awareness more after DMT.

Some meditators have noticed tinnitus symptoms during meditation, likely as a result of developing mindfulness and not being so lost in one’s thoughts, emotions, and sensory experiences. Perhaps DMT-related tinnitus is a kind of super-charged mindfulness (we know that psilocybin can produce long-lasting increases in trait mindfulness), in which case, one is simply becoming more aware of a ringing, buzzing, or hissing sound that was always present.

The ‘reducing valve theory’ of psychedelics may also help shed light on this phenomenon. Aldous Huxley promoted this theory in The Doors of Perception (1954), and it has been used more recently as a metaphor to explain the role of the default mode network (DMN) and its modulation by psychedelics and meditation.

According to this theory, the brain naturally limits the information that reaches our conscious awareness, namely, it blocks out perceptions that don’t serve practical purposes. If a ringing sensation is one such type of perception, then perhaps DMT – like other psychedelics – deactivates this reducing valve function of the brain, thus allowing all sorts of perceptions to enter conscious awareness, including the sound of ringing that is normally blocked out. Persistent ringing, then, would be an example of a persistent weakening of the reducing valve function, with the disappearance of ringing occurring when the reducing valve function returns to normal. However, it is not clear if the reducing valve theory best accounts for these cases of tinnitus. After all, how would this theory account for improvements in tinnitus post-DMT?

DMT is not known to be physically harmful, and there is no evidence that the compound damages the ears in any way. Tinnitus can be caused by physical issues like short- or long-term exposure to loud noises (which can damage hair cells in the inner ear), earwax buildup, ear infections, ear injuries, and head or neck injuries. DMT does not cause these kinds of damage. Some medications – including various medications for cancer, malaria, and infections – can cause tinnitus too, by damaging the sensory cells in the inner ear. (This is known as an ‘ototoxic’ effect.) Yet there is also no evidence that DMT has this effect.

Tinnitus has been tied to changes in the brain’s auditory system, so perhaps rather than causing physical changes in the inner ear, DMT creates temporary changes in the auditory cortex. But again, we have no research on this possible causal mechanism. Perhaps future brain imaging studies could look at whether DMT-related tinnitus involves any changes to the auditory system.

It’s important to emphasise, particularly in the case of anecdotal reports, that correlation does not equal causation. Just because people smoke DMT and experience tinnitus after, this doesn’t necessarily mean DMT caused the tinnitus. Nonetheless, it would not be that surprising to me if DMT could, in some instances, cause persistent auditory effects. After all, DMT use can result in hallucinogen persisting perception disorder (HPPD): the presence of persistent visual effects after psychedelic use that cause distress and/or impairment. HPPD has also been likened to a kind of ‘visual tinnitus’, and it has been observed to co-occur with tinnitus.

Furthermore, we should not be so quick to dismiss anecdotes on experiences of tinnitus following DMT use simply because they are anecdotes. The phrase ‘the plural of anecdote is not data’ may encourage us to dismiss anecdotes, but it’s worth noting that the phrase is a misquote. The original aphorism comes from the political scientist Ray Wolfinger, who expressed precisely the opposite: “The plural of anecdote is data.” Indeed, some scientists support Wolfinger’s view. As the chemist Blair King writes on his blog, “So are all anecdotes useful? Absolutely not. But take a lot of observations that are similar in nature (or mutually-supporting) and suddenly you have the baseline data necessary to start developing a hypothesis. Anecdotes can, and do, provide a valuable information source at the initiation of a scientific investigation of a phenomena [sic]”.

All that being said, we still need rigorous studies – including clinical trials, brain imaging studies, psychological research, survey studies, and long-term follow-ups – to shed light on the purported link between DMT and tinnitus. As far as I can tell, this is one of the least studied (and least discussed) adverse effects related to psychedelic use.

With regards to the factors that precipitate or worsen tinnitus symptoms following the use of DMT (or another psychedelic), I’ve noticed certain factors that seem to increase the risk. These include breakthrough doses, frequent use, and polydrug use. Interestingly, these factors appear to increase the risk of HPPD manifesting as well. In terms of what tends to help people, users often find that abstinence from psychedelics, reducing stress levels, getting enough sleep every night, and looking after their health results in a reduction in symptoms (many of the same techniques that regular tinnitus sufferers use can be helpful). Otherwise, by simply waiting it out, symptoms tend to fade and disappear over time.

But again, we need research on what most strongly predicts the onset of tinnitus symptoms, as well as what strategies are most effective for those experiencing tinnitus after their psychedelic experiences. Some cases of tinnitus – and I’m speaking of tinnitus more generally here – may be caused or worsened by psychological issues like stress. So it’s also possible that the onset or intensity of tinnitus is related to either stress during the trip or other post-psychedelic extended difficulties, much like HPPD is. As Ed Prideaux writes in a piece for the BBC:

For the cognitive scientist Marta Kaczmarczyk, who works with the Psychedelic Society of the Netherlands, one way to think about HPPD is through the body's stress response. Boosting cortisol, heart rate and body temperature, psychedelics could overstimulate the nervous system and lead to forms of "burnout" – producing fatigue, dissociation, anxiety, tinnitus, depression, and other symptoms often associated with HPPD.