Tinnitus as a new experience
When tinnitus first emerges it is a new signal, there are no memory patterns, and no means of categorizing it. Any new experience produces an ‘orienting response’ where we are forced to pay attention, until the signal is classified and understood. Until proper evaluation has been undertaken of what tinnitus means, it will be regarded with understandable suspicion. Many 'sufferers' only experience mild annoyance from tinnitus as a result of this orienting response, but it may be sufficient to promote the need to seek help. A typical, and reasonable anxiety is ‘will it get worse?’ or ‘what happens if it goes on for ever?’
Tinnitus as a threat
For many sufferers, tinnitus is quite threatening. Some people fear that tinnitus means they have some kind of serious illness. Others are convinced that the experience of 'disco tinnitus' means permanent damage to the ear, rather than temporary protective changes, which are normal and universal. There are patients who worry about the possibility that tinnitus heralds a brain tumour, blood clot, or some serious mental illness ("it will drive me mad!"). Many people fear that tinnitus will get louder, continue forever, and cannot be cured. Even the concept that tinnitus is invading one's 'right to silence' constitutes a threat, very similar to the territorial invasions that all animals experience. It is often feared that tinnitus will continue to spoil peace and quiet, interfere with concentration at work, quiet recreational activity and the ability to sleep at night.
The wrong advice
Unfortunately, these fears may be enhanced
by professional advice, or reports from other sufferers, who have had a bad reaction to
tinnitus. Many doctors and other professionals still advise patients that there
is nothing that can be done about tinnitus, and that it will go on for ever.
Other people fear that tinnitus may mean that their hearing is becoming
impaired. Tinnitus may be the consequence of a mild age-related hearing impairment, rather
than the other way around. It is still only twice as common in hearing
impairment, as in normal hearing. In any event, the threatening qualities of the
tinnitus are enhanced by beliefs and negative ideas about tinnitus or
associations that have been formed, not any
physical changes that may or may not have occurred.
Finally, many tinnitus sufferers are angry
about the treatment, or lack of treatment, or inappropriate advice that they
have received. They may feel guilty for having submitted to treatment, which
they think, is the cause of their tinnitus. Fear, anger and guilt are very
powerful emotions, which are intended to enhance survival-style, conditioned
reflex activity, and consequently these emotions greatly increase attention on the tinnitus. In
our experience, tinnitus improves when the patient overcomes these feelings and
stops dwelling on thoughts of injustice.
Tinnitus as a phobic experience
In some patients, extreme fear of tinnitus results in a phobic state developing, very similar to that of the fear of spiders, frogs, small spaces, flying etc. Many tinnitus sufferers also have other phobias, suggesting common mechanisms at work. In the treatment of any phobia a slow process of 'desensitisation' has to be used. First, you must confront the feared object, learn to experience it without reacting, and then to accept it as a normal phenomenon that does not in any way threaten. Many aspects of tinnitus retraining are common to these techniques.
In other people the response to tinnitus is
milder, though still negative in its meaning. Annoyance or ill ease exists, and
although strong emotions may not be evoked, the limbic and autonomic systems are
still being stimulated to produce aversive and intrusive emotions which reduce
life quality. Most importantly, these emotional responses ensure that tinnitus persists, rather than
habituates naturally. These negative qualities of tinnitus, which make people seek help,
are created outside the hearing mechanism, and therefore cannot be helped
by a purely audiological, or ear-related approach.
This is the reason for the failure of tinnitus treatments before TRT.
Tinnitus Retraining Therapy (TRT)
Successful tinnitus management in our
clinics is a result of retraining and relearning. Once the tinnitus loses its
sinister meaning, however loud it has been, or however unpleasant it may seem, it
DOES begin to diminish, and in many cases may not be heard for long periods of
time. In some cases firmly held beliefs are hard to alter, particularly where
there is a conviction that tinnitus is only related to ear damage which cannot
Retraining the subconscious auditory system to accept tinnitus as something
that occurs naturally, does not spell a lifetime of torture and despair, and is
not a threat or a warning signal, can take months and occasionally even years.
Ideally, retraining should be guided by professionals with experience in this field,
forming part of a multi-disciplinary team.
However, many people can be helped by understanding the Jastreboff model
and applying the principles of retraining as described here. For
people who also have co-existing or pre-existing anxiety or depression, it can
take longer to change their feelings about their tinnitus.