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.”