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Why does my tinnitus get louder when I notice it?

Why [does] my tinnitus get louder when I notice it? When I'm not paying attention to the tinnitus, it isn't loud, but when I focus in on it the volume will Increase and it will keep increase (sic) until it's unbearable.

This is a question from my postbag on Quora. Here's my answer:

This is because our hearing has two components. One is the actual physical intensity of the sound wave. The second is the amount of attention we’re paying to the noise.

Tinnitus isn’t a sound, it has no physical intensity that we can measure. However, it seems louder or quieter (or disappears even) depending on how much we are paying attention to it.

With my patients, I ask them to listen to the sounds around them in the room. If you’re at home, you may be able to hear:

* traffic noise outside

* people talking in another room

* the hum of a refrigerator

Any low-level sounds are good for this. Find just one sound in your environment and concentrate on it. If you don’t have enough quiet sounds indoors, open a window or go outside.

Find your sound. If it’s the traffic, think about which street it’s coming from, picture the car/truck and which way it’s going. Do this for a full minute or more. The more you ‘attend’ to the sound (focus on it) the more prominent it will get in your soundscape. You may start to pick out details that weren’t there before. It doesn’t increase in actual, physical intensity, but it can seem ‘bigger’ somehow.

It’s like seeing a magazine page. First you see the page of text/images, but then you need to attend to it in order to find the individual articles or paragraphs. You might scan it for a specific word, and when you’re thinking about the word, it feels like it jumps up from the block of text.

Back to the hearing exercise. Try and pick out a different, quiet-ish, sound now from your environment. Perhaps the hum of an insect. Think about where it’s coming from, is it moving or getting closer? If it’s the refrigerator hum, does it have breaks in it, or is it constant? Did it get quieter when someone shut the kitchen door? The more thoughts you give to the sound, the more attention you feed to it, the more prominent that sound can become.

You might notice that the original traffic noise has become a bit quieter while you listened to and thought about that second sound. Although you can still hear different sounds, and they’re all fairly quiet, they come in and out of focus.

Now, try switching between the two sounds. Each for 15 seconds. You should be able to pull one out of the environment at will, examine it, then put it away. The sounds are all still there though.

With environmental sounds, they are there all the time. Very rarely are we completely in silence. But the vast majority of the time, we’re not aware of that traffic, hum, wind etc. Tinnitus is not a sound, and it doesn’t have ‘intensity’ in the usual way. It pops up into our field of hearing, and if we pay attention to it, we can make it more prominent. But why would we want to? Why would we give it attention, when we know it’s not interesting? Why would you feed it by thinking about it, by getting angry with it? It’s not helpful to focus on it, and there are more interesting things to listen to.

If you are finding it difficult to stop yourself from attending to your tinnitus, practice the above exercise until you become a master at pulling sounds out of the background and making them more prominent. The tinnitus is not a sound, and it doesn’t have to behave like one. This is great news, because that means you’re not stuck with it. If it was a burglar alarm going off next door, you would be stuck with it. But tinnitus can be largely ignored.

Every time you notice the tinnitus signal, immediately make yourself ‘pull up’ a sound from the environment. This is a useful technique because you should always have access to sounds. Make it a habit to always stop attending, and search for a physical sound signal. If your home is very quiet, you can crack open a window or put the radio on in a different room. Then, if it pops up, you can switch focus to the traffic noise.

You have already learned that tinnitus gets louder if you focus on it. Now use that knowledge to ensure you don’t keep doing it. Do not say/think the word "tinnitus". Call it T or something totally unrelated, so that you’re not reinforcing it. If it pops up, think to yourself, “Hello T, and goodbye!”, then pull out a sound in the room, or get up and make a cup of tea. Do anything that isn’t sitting quietly and listening to your tinnitus.

All our senses tend to work like this. New sensory input - such as a breeze on the hairs of our arms, or someone moving at the edge of our vision - get our attention automatically. The brain hands you the input so you can figure out whether to pay attention or let it go. Once you know what’s happening (it was the breeze on my arm, not a poisonous spider), you then ignore the sensory input and it goes back into the background.

Trust me when I say that T works this way too. The vast majority of the time, you can move your focus and it will drift into the background. There are a couple of exceptions, but never-ever-ever will you make it smaller by attending to it. So do yourself a favour, and do not spend one moment more examining the tinnitus signal.

At this point in my consultation, people will sometimes say, "ah yes, that's all well and good, but my tinnitus is*...". It really, truly doesn't matter what the individual circumstances or triggers for your tinnitus are. We are all human beings, built the same way. We are all capable of changing our attention, even if we need to practice it. We are all subject to sounds, and we are not going to like all of them. But what happens after your brain hands you that signal - that is up to you and within your power to decide.

*different tone, louder than yesterday, comes on when the advert breaks appear, goes up and down, sounds like a whistle, sounds like a foghorn. The list is endless.

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