This question comes up from time to time with my patients, and in my support group.
We talk about baselines, triggers and spikes - these are all handy labels to describe what’s happening with your tinnitus and why, but the important thing to remember about tinnitus is that it actually does not exist in the physical sense, and it can do what it wants to do. It has factors that are common across all individuals, it also has aspects that seemingly defy logic. If you expect to control or predict it, you are setting yourself up to fail.
Too often, people think of tinnitus as a physical ailment. They can compare it to sound, which responds logically to physical factors such as air movement, input levels, barriers etc. Tinnitus is more analogous to pain, it’s a sensation that can be worse or better due to context. It comes from within, not from the outside. A small pain can take your mind off a larger pain. An intense pain will take all of your mental focus. You can’t concentrate until the pain subsides.
Any one of us with T can have it spike (seem much louder than usual) due to stress, change of medication, anxiety, silence, loud noise, and/or one of your own personal triggers (something that brings T to your attention).
Whether it goes back down to its baseline (usual pattern / level of ‘volume’) is down to several things:
1) Whether the trigger has really gone away
2) Whether you have lost your ability to habituate
3) How you feel about the T, deep down
Example: someone with mild hearing loss may occasionally notice their T, in a quiet setting only, or when they are very stressed. They can cope with this, it’s not often, and they find they can distract themselves as needed. They are not afraid of the tinnitus, it is a minor irritant. They feel like they are habituated, and to an extent, they are, but more realistically they haven’t really been tested.
That person can lose more hearing over the years, but they are still habituated to their T. It may need less to bring it to their attention these days, but by and large they are not bothered.
Then, they go through an extended period of stress. House move, divorce, unemployment, grief. So many things in life can rock your world this way.
The T spikes. It seems very loud (it doesn’t have volume, but this is how it’s perceived). It “comes forward”, so the person struggles to hear sound. It is in fact, not loud, nor is it sound, but that doesn’t matter. It’s diverting your attention from sound and that’s what matters.
After a few weeks or months of this, the person is no longer habituated. They fear the T, they pay attention to the T, they focus on the T. After a quiet spell, when the T pops up, they have a reaction - either consciously or subconsciously. It does not matter how strong you are, how logical you are, you are starting to despair that this is your life now.
Under these circumstances, even when the trigger is long gone, the person will suffer. It has become self-sustaining, because the reaction to the T is itself a trigger. This is what it means to not be habituated, truly, and it is awful.
What we now need to do is take that person and everything they think they know about tinnitus, pull it apart and start again. Only solid information going in. All the bits and pieces they’ve read on the internet need to be confronted and replaced with truth.
Anyone, anywhere can habituate to tinnitus. Yes you will have spikes, but when you know that they will go, you do not need to be afraid, you do not need to react. Reacting simply feeds the T. We get to a place where the T is a fleeting irritant.
That work though, that stripping down/rebuilding, needs to be done in my opinion. You have to understand the nature of T in order to not fear it. It should be so far down your list of thoughts and priorities.
This is the difference between those who have tinnitus and those who suffer from tinnitus. It’s the same condition, but it should be the background noise, no more.
©️ Sally Jackson BSc Hons (Audiology), RHAD, MSHAA
Senior Audiologist / Owner at Hearing and Tinnitus Care
Contact sally@hearingandtinnitus.co.uk if you wish to reproduce some or all of this article.
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