Managing Tinnitus

Managing Stress

It has now been proven that practising Mindfulness is a helpful technique to use to calm down your tinnitus and doing so on a regular basis is something that should be considered.   The aim is, not only to make peace with yourself but also to make peace with your tinnitus.  Once you have achieved this aim, your tinnitus will recede into the background as you learn to manage your emotions, anxieties and irrational thoughts and reactions.

 

Because stress is so closely linked to the emotional system, negative thoughts and feelings, along with worries and anxieties, will cause tinnitus to be intrusive so it is important to try to reduce stressful situations as much as possible.  Sometimes this may mean looking at your lifestyle and making some changes to minimise your stress.

Muscle Relaxation and Visualisation

Muscle relaxation is also very helpful.  If you lie on the bed and start from your toes, squeezing/tensing and then relaxing all your muscles right up to the top of your head, this helps to release tension in your body.

Visualisation is also a good idea.  Whilst relaxing and possibly, tensing and relaxing your muscles, visualise a place where you have either been, or maybe where you would like to go to (or even somewhere you imagine) – a place that is peaceful and relaxing.  This type of visualisation can also help to ease anxiety.

Do not shrink your lifestyle

It is very important not to shrink your lifestyle by thinking that you cannot enjoy all the things that you enjoyed before tinnitus.    Doing all the things that you enjoy (taking precautions where necessary when being exposed to extremely loud sounds) and enjoying your life to the full will certainly help you in distracting your thoughts from tinnitus.   Try to have as much daylight as possible, embrace nature, your garden and everything around you, and do a mindful breathing exercise.  Engage in a hobby, reading, writing poetry, journaling and anything that will engage your attention in something pleasant.

Music

Listening to music can stimulate a calmer emotional response and so it not only helps with relaxation but also allows your attention to focus elsewhere.  Classical music can have a beneficial effect by slowing the pulse and heart rate and decreasing the levels of stress hormones.

 

Perception and Tinnitus

Why do we react to Tinnitus? Why does it appear worse at some times than others?   

To answer this, we can look to some basic principles of the psychology of perception.    Our sensory systems provide vast amounts of information on the objects and events around us, but too much for us to utilise effectively.

To do that we need perception, the process by which we become aware of the information and make sense of the incoming data so as to allow us to interpret it in a meaningful way and act accordingly.

Perception

Sensation and perception are two separate processes that are closely intertwined.  Sensation represents the ‘input’ – in this case our tinnitus and the perception is the process by which the brain selects, organises and interprets these sensations.

Perception is a creation, it is our brains, mind and the neurons inside our heads creating the world for us.

When we hear a stimulus – our tinnitus – the first thing we do is attend to it – pay it attention.  We need to do this because we need to process it.  This is not the end of the process because then we need to recognise it.  As it is an internal sound and not one we are used to – it becomes frightening because we can’t recognise it.

However, perception also takes into consideration our prior experiences, the effect of memory, learning and previous encounters with a similar stimuli.

Think about your Tinnitus – what does it sound like?  

High pitched whistle – could it be like a warning – need to move to be safe

The sound of a pressure cooker – we need to react because it may boil dry

The sound of the television when it used to close down in the evening – we need to react, switch it off.    

To all of these sounds you need to take some action to stop it

Attention

We are continually bombarded by stimuli, but we are not always aware of it.  We don’t always feel the pants we are wearing unless we pay attention to them. One of the ways we manage tinnitus is by bringing in other stimuli for our senses. However, if we focus intently on our tinnitus we could miss the other stimuli (inattentional blindness).

In a famous study by Daniel Simons and Christopher Chabris (1999) participants watched a video of people dressed in black and white passing basketballs.  Participants were asked to count the number of times the team in white passed the ball.  During the video, a person dressed in a black gorilla costume walks among the teams.  You would notice a person dressed as a gorilla surely as it is so unusual?   Nearly half of the people who watched the video didn’t notice the gorilla at all.  They were so focused on the people passing the ball they completely tuned out other information.

This may be why you perceive your tinnitus even with the TV on or in a football match

Management Tip 

Try listening mindfully to your favourite piece of music or song.  Can you make out all the words?  Distract yourself from your tinnitus by concentrating on your other senses – sight, smell and touch.

Motivation

Motivation can also affect perception.  You may not want to be paying attention to your tinnitus but you are tuned into.  Motivation can be positive and negative.  It may be whilst waiting for an important call, you think you hear the phone ringing whilst in the shower.

It is the same effect when a mother sleeps through a thunder storm but hears the slightest cry of her baby, she has an emotional reaction to this sound and so reacts to it and not other stimuli.  Again, you perceive your tinnitus in a noisy environment because you are tuning in to it.

Contrast 

Contrast also affects our perception.  If someone’s mobile phone lights up in a dark theatre before a performance, you will most likely perceive it but if the same phone lights up in the well-lit bar in the interval, you will not notice it.

A number of our group members state they notice their tinnitus after being in the car and coming in the house.  This is the contrast between the noise of the engine and the quiet house.  Of course, tinnitus is most noticeable at night when you have had other stimuli around, maybe the TV, radio or your partner talking and then suddenly the quiet bedroom.

Management Tip

Try sleep Apps or under-pillow speakers. Pillow Speakers are available from the British Tinnitus Association.

https://www.tinnitus.org.uk/pages/shop/department/pillow-speakers-and-sleep-headphones

Conclusion

Perception is a complex process, we all have different beliefs, values and life experiences which affect our perception. Our experience of tinnitus is, therefore, affected by all these things.  However, understanding some of the basic psychological principles which affect perception can help us to make sense of our experience of tinnitus.

References: British Tinnitus Association – https://www.tinnitus.org.uk/

Future Learn

https://www.futurelearn.com/courses/sensation-perception/7/todo/72694?utm_campaign=sensation-perception-w

https://cnx.org/contents/Sr8Ev5Og@12.2:K-DZ-03P@12/5-1-Sensation-versus-Perception

 

 

 

 

 

 

 

 

 

 

Understanding Tinnitus

Tinnitus is the conscious awareness of a sound that is not due to an external source and affects about 1 in 8 of the population.

Understanding Tinnitus

However, tinnitus is closely associated with the emotional system (in particular the amygdala) which is part of the limbic system and is responsible for the “fight or flight” response.  When a threat is perceived (as in the onset of tinnitus), it impacts on how we process this new sound, causing survival changes in the body and mind which result in the fight/fright or freeze response.

Although we look very different to our ancestors (the caveman) we have not evolved (emotionally) since then, our brains still have basic primitive reactions. Thus, the sound of “tinnitus” elicits the same stressful response as it did to our ancestors as the noise heard by our ancestors may have been that of the sabre-toothed tiger.  But our stressors today are many and varied, from work related stresses, relationships, bereavement and many more.   Even though our modern-day stressors are very different to those of the caveman, our emotional reaction to stress and anxiety is still the same.

Hearing loss and tinnitus

Although noise can cause tinnitus there are other factors that can result in tinnitus, such as illness, some medications and injury.  Warning: never stop taking your prescribed medications – you must always speak to your GP.   For many people, stress and anxiety seem to be the trigger for their becoming aware of tinnitus, which is, of course, because of its close link with the emotional part of the brain.  However, hearing loss can also be a trigger for tinnitus as the brain searches to hear the missing sounds, tinnitus may be heard.  You may not always be aware that you have a hearing loss as, for many, it comes on gradually.

The first-line treatment at hospitals, for those who have hearing loss and tinnitus, tends to be fitting hearing aids which can be effective in reducing the perceived volume of the tinnitus as it allows you to hear external sounds more clearly and thus the brain doesn’t have to ‘search’ and strain to hear sound.

The sound of silence

There is no such thing as ‘silence’ and the following will explain this.  In a study carried out in the 1950s by two American researchers (Heller and Bergman) they placed 80 students who did not have tinnitus, one at a time, in a soundproof room.   Afterwards, approximately 94 per cent of those people experienced a sound sensation such as hissing, ringing or buzzing when listening to ‘silence’.

More recently a similar study was replicated at Nottingham Hearing Biomedical Research Centre but with a twist.  They put people in a soundproof room and 83% reported hearing sound and then they put in a non-functioning speaker and the number of people who reported hearing sound went up to 92%.  These people did not have tinnitus and had normal hearing.  All of them heard some sort of sound when there was absence of any kind of input which indicated there is more to tinnitus than just the hearing of sound itself.  Attention or focusing on tinnitus plays a key role and I think everyone who has tinnitus will agree that they do tend to focus on their tinnitus.    But things do change and your brain does learn to filter out the sound once it becomes unimportant to you as you learn more about tinnitus and how to manage your emotional reactions.

Selective attention

There is evidence that our attention picks up tinnitus to focus on rather than other sounds and this can be heightened by monitoring to see if “it” is still there.  However, our ‘hearing brain’ has the capacity to filter out sounds that it considers unimportant.  We can help this process by using our other senses – sight, touch, taste, smell and choosing to do so will help in the process of “habituation”.

Habituation

This is a process by which any continuous stimulus (ie tinnitus) results in a process called habituation.  Once your reaction to tinnitus diminishes, there will be an automatic reduction in the perception of tinnitus.  However, should you notice it, your reaction will be somewhat diminished and so it will not trouble you.  One of the important things in life is to make peace with yourself, in doing so, you will make peace with your tinnitus.   However, in order to maintain habituation to tinnitus it is easier if it is heard from time to time so you can reinforce your beliefs that tinnitus is nothing to fear.

Patient Pathway

It is important to get a proper diagnosis so seek advice from your GP.  As there is now NICE Guidance for Tinnitus patients, there is an appropriate patient pathway that GPs should follow.  Depending on the diagnosis this may be a referral to ENT and/or to Audiology for further assessment.

https://www.nice.org.uk/guidance/ng155

Disclaimer

We are the Chesterfield and North Derbyshire Tinnitus Support Group.  We are not medically trained.  Our Lay Counsellor has experienced tinnitus since 1984 and, through making peace with her tinnitus, she has been able to live life to the full, in fact, she says, “experiencing tinnitus has helped me to manage, not only my tinnitus, but also all the other hurdles that you need to negotiate in life as well as making lots of friends along the way.”

 

 

 

 

 

 

The Poetry Buzz

Thanks to money from Five Ways to Wellbeing we were able to introduce our Poetry Buzz workshops.  These were fun and interactive and everyone was brave enough to share their work and supportive and encouraging to each other.  Many were surprised at their poetic achievements.  The project won most innovative project at the Voluntary Sector Awards in 2018

Thanks to Derbyshire Voluntary Action – Small Grants Scheme  we were able to secure money to continue these workshops.

We meet every month at Loundsley Green Community Centre, Cuttholme Road, Loundsley Green, Chesterfield S40 4QU from 1.45pm – 4.00pm.

The themes this year relate to our memories

Poetry written by our members

February  – Wednesday 26th  – A stitch in Time

March  – Wednesday 25th – Food Glorious Food

April – Wednesday 29th- Sugar and Spice

May/June – Wednesday 3rd June – Buses, Trains and Automobilies

July – Wednesday 22nd  – Rummage in the Toy Box

August – Wednesday 26th – On the Screen

September – Wednesday 30th – All dolled up

October – Wednesday 28th – Keeping it Clean

November – Wednesday 25th – Christmas Past

The feedback was all very positive.

The following question was asked “Three words that sum up how the Poetry Buzz has made you feel”

“Happy, Uplifted, Relaxed”

“Inspired, Happy, Joyful”

“Positive, Fun, Encouraged.”

Wellbeing Workshops

Our Wellbeing Workshops will begin again in September.

Understanding tinnitus and the perception of tinnitus is important in helping people to learn how to manage the condition. Within our Tinnitus Wellbeing Workshops we promote understanding of the mechanisms of tinnitus in a way that is easy to comprehend.   Peer support is important and the workshops provide this in a relaxed atmosphere. We have developed a range of support techniques and strategies that will help people to manage stress, not only to tinnitus but also other situations in life .

The Tinnitus Wellbeing Workshops run as a set of 4 which will take place at Loundsley Green Community Centre, Cuttholme Road, Loundsley Green, Chesterfield S40 4QU from 1.30pm – 4.00pm dates for 2020 to be confirmed.  However, if you are interested please give us a call so we can put you on the list for 2020.

The workshops will be for a small group of people, they are really interactive and friendly allowing everyone to share their experiences, ask questions and learn from each other.

If you would like more information about the workshops or how to find the venue please contact Joanne on mail@tinnitussupport.org.uk or telephone on 01246 380415

Feedback from our workshops

“As a result of the workshops I have made changes and communicated better with the family and in social situations”

“The course has made me think about how Tinnitus has affected me.”

Soup and Socials at the Badger

Wednesday 18th March 2020  11am – 1pm

Soup and Social at the Badger Pub, 81 Brockwell Lane Brockwell Lane, Chesterfield, S40 4ED

This will be a the first of our Feel Free talks, where our members, committee and supporters can share a topic they are interested in.  Many of our members have other hobbies, have led interesting lives and we would like to find out more about you.  Our Co-ordinator – Joanne Gordon will give a talk about Chesterfield Theatre Company Formerly Chesterfield Playgoers, as well as informing you about their forthcoming production.

Previous meetings

I have no time for Tinnitus – Muriel’s Blog

I have no time for Tinnitus, for I’m as busy as a bee

living life to the full, like a bird that’s been set free.

You came into my life and left me in such a mess

until I realised that paying you attention was heightening my stress.

So I will suppress you, compress you and ignore you, until you set me free

for there is one thing you can be sure of, you will not feast on me.

 

I have no time for Tinnitus. I refuse to let you intervene

and strongly refute that you’ll prevent me from being the person I’ve always been.

Though we’ll always be together – I fully understand,

but be sure of one thing – that I will not allow you to take the upper hand!

There is life after Tinnitus, while as yet no cure has been found –

if we manage our condition and remain positive, we can turn our lives around.

Like the soldier back from battle, the war has left him lame.

He picks up the pieces and goes forward, so we must do the same.

 

I have no time for Tinnitus, so I’ll ignore you all I can.

You are very prevalent and the blight of many a man.

We must always remember that life is for living.

Tho’ events can beset us which are quite unforgiving.

So we must stay with the moment and never look back,

keep the present in mind so that we remain on track.

The future is for tomorrow – the past already gone.

 

So Tinnitus sufferers everywhere let us each and every one –

state, that we have no time for Tinnitus, with one united voice

for if we grasp the help that’s out there, then we do have a choice.

Finally, our message to Tinnitus – to leave you in no doubt

that our aim will always be – to try and stamp you out!

Chiropractic and Tinnitus Article by Priscilla So

I’m sure as tinnitus sufferers you probably know a bit more about the different symptoms, causes and issues than I do.  All I know is that in my 7 years of practice and my father’s 17 years of experience, we have helped numerous people reduce the frequency or severity of tinnitus or even report that it has completely disappeared.  Of course we know there are many reasons why people develop it and there are often many other symptoms that appear with it.  As Chiropractors we don’t treat symptoms as such and so I think I better explain exactly what it is we do do….

Usually a person comes to see us because they have a specific symptom that is bothering them such as low back pain, knee pain, headaches etc.  We always take a full medical history, neurological and chiropractic assessment of every person that walks in the door.

The body is controlled by the nervous system, the brain has nerve fibres that travel through the spinal cord and exit at every level of the spinal column.  I sometimes describe myself like a posh electrician because I help to make sure there are no blockages to the wiring that makes your body work.  The diagram shows where these nerve connections exit along the spinal cord and what areas of the body they supply.

Every cell in the body has to have communication to the brain to know how to function. The brain tells the cells what to do, but it also needs to receive information from the nerve fibres to know what is going on.  For example; if you need to move your wrist, your brain receives information all the time from the tissuesaround the joint and the joint capsule about where they are in space (proprioceptive nerve fibres) and what’s going on, this happens without you being aware of it. The information travels from the wrist through the elbow, the shoulder, up into the spinal cord in the neck and into the brain and back again.  If I damage my wrist, elbow, shoulder, neck or brain, that’s going to change the way the body moves that area or the muscles it can make fire.  I might notice that I can’t grip so well, that things seem particularly heavy or I might not notice anything different until because I’m using the muscles incorrectly, I start to damage them and feel pain. Tinnitus essentially is the nerve fibres in the ear being triggered as though they are responding to noise and telling the brain that there is sound, even when there isn’t. So what can cause certain nerve fibres to fire off?

There are three main things that can impede the function of normal nerve communication and so proper functioning of the body, they are:

 

Physical Stress:  so you can have a fall, you injure yourself, the body stops certain muscles and joints from moving while they heal and in the meantime you recruit different structures to move you, maybe in time damaging them and leading to symptoms. There can be changes in function before you notice and before you may feel symptoms.

We know that there are certain nerves that supply the ear and control its function, they exit from the top of the cervical spine, so if there is some problem with the joints, muscle and soft tissue in this area it can lead to nerve fibres firing off because they’ve been stimulated by damage, inflammation or abnormal movement, this can lead to symptoms, one of which may be tinnitus.  It is common not to have any symptoms in the neck with only tinnitus noticed.  That is why we as chiropractors look at function; do the joints function properly in their movement?  If they don’t then there is a problem.

Additionally the functioning of the jaw can have an effect on the ear, simply because of its proximity and its relationship with the surrounding musculature.  That is why some tinnitus sufferers may also notice their jaw clicks, pops or locks.  Chiropractors can also look at the functioning of the jaw, both the joint and the musculature and help correct this.

 

Chemical stress:  Are you eating the right foods for your body to repair, maintain and produce the chemicals to keep you working.  Bacteria, viruses and chemicals in the environment also cause changes to your body that affect its function.

Did your symptoms start after an illness or infection?  As chiropractors, not only can we check to see whether there is any structural issue that may have aggravated the problem and help that, for example; a kinked Eustachian tube, a problem with how the jaw moves or cervical joint issues which affect how well the ear drains.  We can also talk to you about supplements and diet which may help your immune system if you feel you’re prone to infections.

Are you eating the right foods for your body to heal and repair?  We know that a lack of certain essential minerals or vitamins can impede nerve function and cause chemical changes in the body.

That’s why Vitamin B12 and zinc is sometimes recommended for sufferers.

 

Emotional Stress:  I know that when we feel tired, down, hungry or generally stressed, symptoms can appear.  The problem is probably there all the time but when our bodies are not coping very well we produce more stress chemicals and our bodies become less able to cope with stress, like the additional nerve firing from an overstimulated nerve cell in the ear.  Also symptoms can appear worse at night, this is simply because there is less to distract the brain, the nerves may be firing all the time and the brain can ignore it for a while but at night time it can seem worse, this is also true of people that see us because of pain.

So how can chiropractors help?  Well we believe that the body is self-healing and self-regulating, we just enable the body to heal as well as it can. Of course if you have suffered long term damage to the ear, this may not resolve completely or heal but it’s always worth seeing if there is anything else that is making it worse or aggravating it. As I hope I’ve explained; diet, stress and physical problems can all contribute to the symptoms you may be suffering.

My advice, give your body a break, make it easier for it to function by drinking enough water, eating well, sleeping well and visit a chiropractor to make sure there are no additional structural issues that may be causing stress to the body.

Priscilla So Masters (Chiropractic) DC

Advanced Rated Activator doctor.

 

Priscilla is the owner of two practices in Matlock, Derbyshire and Bedford, Bedfordshire.  She works in the Matlock Clinic and Frank, her father and Esther Kong practice in Bedford. Frank, Priscilla and Esther use the Activator technique; a hand held device which delivers a specific gentle thrust to move a joint, normalise nerve function and reduce inflammation. The activator protocol specifically determines which structures are involved and in what direction they need adjusting, so the treatment is precise, measurable and gentle.

 

so-healthy.co.uk

Tinnitus research priorities established

After months of hard work, the James Lind Alliance (JLA) Tinnitus Priority Setting Partnership (PSP) has published the top ten research uncertainties for tinnitus agreed by patients and clinicians. It is hoped that these will be a catalyst for more tinnitus research and encourage funders and researchers to rise to the challenge of addressing the selected priorities.

The top ten research uncertainties chosen were:

  • What management strategies are more effective than a usual model of audiological care in improving outcomes for people with tinnitus?
  • Is Cognitive Behaviour Therapy (CBT), delivered by audiology professionals, effective for people with tinnitus? Here comparisons might be with usual audiological care or CBT delivered by a psychologist.
  • What management strategies are more effective for improving tinnitus-related insomnia than a usual model of care?
  • Do any of the various available complementary therapies provide improved outcome for people with tinnitus compared with a usual model of care?
  • What type of digital hearing aid or amplification strategy provides the most effective tinnitus relief?
  • What is the optimal set of guidelines for assessing children with tinnitus?
  • How can tinnitus be effectively managed in people who are Deaf or who have a profound hearing loss?
  • Are there different types of tinnitus and can they be explained by different mechanisms in the ear or brain?
  • What is the link between tinnitus and hyperacusis (over-sensitivity to sounds)?
  • Which medications have proven to be effective in tinnitus management compared with placebo?

David Stockdale, Chief Executive of the British Tinnitus Association said, “I am delighted with the top ten research uncertainties that have been selected as they represent a clear focus for future research as well as really capturing the questions that are important for patients and clinicians alike.”

Working with the JLA, the process of choosing the uncertainties began in September 2011, with patients and clinicians submitting the questions that they would like to see researched. Over 2500 questions were subsequently posed. A pooling and filtering process then took place removing anything previously researched leaving 393 questions. This long list was refined to 170 by removing those questions selected by only one or two people. These were then distributed within the tinnitus community so that patients and clinicians could choose their top ten. A shortlist was produced from these responses and discussed at a meeting in London on 16 July 2012 where both patients and clinicians finally agreed on the top ten.

The James Lind Alliance (JLA) Tinnitus Priority Setting Partnership (PSP) was led by the British Tinnitus Association (BTA) and the NIHR Nottingham Hearing Biomedical Research Unit.

The tinnitus uncertainties will now appear on the UK Database of Uncertainties about the Effects of Treatments (UK DUETs). UK DUETs publishes treatment uncertainties from patients, carers, clinicians, and from research recommendations, covering a wide variety of health problems.

The top ten tinnitus treatments uncertainties will be launched at the British Society of Audiology (BSA) Conference on 5-7 September 2012. Deb Hall, Director of NIHR Nottingham Hearing Biomedical Research Unit, said: “The outcomes from this project provide a much needed boost to tinnitus research because they identify specific questions for scientists to address that will bring about real patient benefit”

Making a noise on Tinnitus

The following information was extracted from a report in the ‘compensation’ section of ‘hazards’ – The Workers’ Health and Safety Magazine (April-June 2012)

“Unions are drawing attention to a neglected occupational health issue, tinnitus, caused by exposure to noise at work.  The condition leads to buzzing or ringing noises in the ear.

Tony Rupa, head of legal services with the Communication Workers’ Union (CWU), said: “People traditionally associate tinnitus and hearing damage with heavy manufacturing and music industries, but there are many people who work in the communications sector who are exposed to loud, continuous and high pitched noises.”

He added that the union “is assisting around 3,500 members with claims arising from the use of oscillators/amplifiers in their work, many of whom are suffering with tinnitus.”

Stephen Starosta received £7,500 from BT to cover the cost of equipment to help deal with his tinnitus.

The 56-year old started work for the company as a telephone engineer in 1989.  His job involved using BT’s ‘green set’ and ‘yellow set’ oscillators, devices that transmit a constant high pitched sound through a headset, allowing the user to listen for changes in tone and track faults in telephone cables.

Although the telecoms giant has since admitted that the equipment is dangerous and has withdrawn both oscillators from use, Stephen and his lawyers are concerned that other companies, who have been sold the old devices by BT, are still putting workers at risk.

Rail union ASLEF took up a compensation case on behalf of a member who developed the condition after a faulty train door slammed with an explosion-like bang.

The train driver, who is employed by Northern Rail Ltd, was left with tinnitus in his right ear.  This affects his sleep and means he is unable to concentrate on reading.  As a result of the condition, company policy meant that he was unable to drive trains for a year and was put on light duties for six months.  After receiving specialist treatment for his tinnitus he has been able to return to his job full-time.”