What happens after habituation?

People that have had tinnitus for while, usually under a year, have often asked me this question as they look forward to the day they will habituate. Some wonder will they habituate to the point where they no longer hear the tinnitus? Will they be able to do everything as they did before the onset of the condition? Going to the movies, the gym or attending a nightclub. Listening to music through headphones and whether it’s necessary to continue using sound enrichment at night? There are many questions surrounding tinnitus and habituation, hopefully, I’ll be able answer some of them.

When tinnitus is severe and intrusive and a person has had to seek help at ENT, it can become quite a complex condition to treat. Therefore, it can be difficult to be specific and say how a person will feel and what they are able to do once habituation is achieved, because one rule won’t suit everyone. Another thing to keep in mind is that many things can cause tinnitus. So, I will try to narrow things down a little and focus on the most common cause of it, which is exposure to loud noise. Again, we are all different, so my suggestions are for guidance only should anyone wish to try them.

Some people believe habituation means they will no longer hear the tinnitus but this is not necessarily the case. However, it’s true that for some people their tinnitus has reduced to such a low level they hardly ever hear it. By contrast, others hear their tinnitus in the background and can live quite contently doing all the things they want to because their brain has learned to ignore it, and that’s what habituation is – learning to live with something. It takes time but can be achieved by most people even if your tinnitus spikes occasionally.

I see no reason why a person can’t go out and enjoy themselves at a nightclub or the movies providing they take the necessary precautions and wear noise-reducing earplugs.

They won’t impair sound quality but will reduce external sounds to a safe level when in a noisy environment. They are readably available, reasonably priced and discreet. When using gardening equipment such as a petrol lawn mower or electric power tools I advise using ear defenders.

Quite a few people have contacted me saying their tinnitus has become worse during and after running, and over time noticed it become more intrusive so have had to stop. I believe this more than just coincidence.

My theory is, running on hard ground or on the treadmill causes impact underfoot and this travels up through the body towards the head and auditory system. The vibrations might be irritating the cochlea (in the inner ear) making the tinnitus worse. I have no doubt not everyone will be affected in this way but it’s something to consider if you notice your tinnitus getting worse after a run.

The same applies when at the gym, see how you feel on the equipment that you use and adjust your workout accordingly. I use an elliptical/cross trainer machine and haven’t noticed any adverse affects.

The reason might be, while using it my feet don’t make contact with the ground so no impact is felt or transferred up through my body.

Headphone use and tinnitus has caused many discussions in tinnitus forums. Some people are adamant that they do no harm as long as the volume is kept low and some ENT doctors agree with this. Others like myself including some ENT doctors believe they shouldn’t be used even when listening at low volume. As previously mentioned, my focus is on tinnitus that was caused by loud noise exposure. I believe once the cochlea has been affected by exposure to loud noise, it is much more sensitive to sound and therefore headphones shouldn’t be worn.

I have counselled too many people that habituated to tinnitus, returned to using headphones and noticed their tinnitus becoming worse even when the volume is kept low.

A common word used in tinnitus forums is: “Reactive” tinnitus. A person affected will usually say: “ I have habituated but my tinnitus is reactive to certain sounds”. I believe there is some confusion.

Someone that has tinnitus especially when caused by loud noise exposure, hyperacusis (sensitivity to certain sounds) is often present.

If hyperacusis isn’t treated the auditory system will always be sensitive to certain sounds, even after habituation has been reached. It is for this reason the use of white noise generators (wngs) is recommended to help desensitize the auditory system. White noise generators are normally used as part of TRT (tinnitus retraining therapy) and must be adjusted correctly as not to irritate the inner ear (cochlea) when wearing them. This treatment is best done under the care of a Hearing Therapist or Audiologist.

When a person says they have “reactive tinnitus”, in my opinion, they are not aware they have hyperacusis, which is causing their tinnitus to spike when they hear certain sounds.

Although hyperacusis can improve by itself with time and without treatment there is no guarantee. For this reason I often recommend a person to use sound enrichment (sound therapy) as it helps to desensitize the auditory system.

I believe anyone that has tinnitus should use a sound machine especially at night because the brain and auditory system never switch off. There are mixed feelings about using sound enrichment at night but the benefits are often realized once a person stops it.

People have contacted me saying they have noticed their tinnitus starting to become more intrusive after they have habituated for a while. I usually ask if they are continuing to use sound enrichment at night. Often I am told they have stopped using it thinking all was now well. Inside the human body can be a noisy place but our brain has learned to filter out much of this sound so it doesn’t focus on it. Anyone with tinnitus that sleeps in a quiet room after habituation risks making their tinnitus more intrusive.

If the brain hears silence while we sleep, it has the ability to increase its background activity and at the same time increasing the tinnitus making it louder and more intrusive during the day and night. A person might not notice this straight away, as it’s usually a gradual process.

A sound machine works while we are in deep sleep. It supplies the brain and auditory system with sound enrichment. Over time, the tinnitus is pushed further into the background making it less intrusive and will help make the path to habituation easier. It is usually best to have the sound machine playing in the background at a low level (below the level of the tinnitus) without drawing attention to itself unlike a radio.

For this reason music is not the best source to use at night as it draws attention to itself.

I believe once a person habituates to tinnitus they should try and carry on with their life doing all the things that they want to and take precautions when being around loud sounds.

Michael

PS: Habituating to tinnitus often seems shrouded in mystery but I don’t believe there’s anything mystical about it.

We all habituate to different levels because tinnitus comes in many forms and intensities and no two people experience it the same. Some people have large fluctuations in their tinnitus and every day is a different experience. At times this can be difficult to live with and medications may be required to help cope with the condition. This type of tinnitus is one of the most severe but habituation is still possible, to an extent but does present additional problems.

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  • Hi Michael, I am taking my time to read the document you kindly emailed me. I wish that exact information had been handed to me at the audiology clinic when I got T as it is so comprehensive and answers most of my questions. I may not have got to this section of your document as yet, but I would like to know how best to habituate to pulsatile T? I generally wake up with it but when I put in my hearing aids it gradually disappears - but of course I know it is waiting to re-appear at the 1st opportunity! My T sound changes during the day too - and many changes during the past 18 months - including ringing or hissing, thankfully quiet enough on most days not to annoy me. What would be your thoughts on pulsatile T? Thanks. Angela xx

  • Hi Angela,

    Thank you for your kind comments about my article. It may not seem like it but it took me many months to write, for I have never done anything like that before. My tinnitus can be very intrusive and caused me lots of problems in the process and I gave up many times feeling that I couldn't go on. So your comments and others that I've received at Tinnitus Talk, are much appreciated and has made it all worthwhile if people get some help from it.

    I don't know a lot bout Pulsatile tinnitus. For this reason, I mentioned early on in my article, that I mostly deal with noise induced tinnitus. However, people with Pulsatile tinnitus have benefitted using the same treatments as the people with "noise induced tinnitus". These are: TRT, CBT the wearing of hearing aid/s etc.

    If you have Pulsatile tinnitus then I still feel the advice that I given will help you. Try using sound enrichment at night once you take off your hearing aids. You might also benefit from tinnitus counselling with a hearing therapist, if it's available to you via a GP referral. Tinnitus can change quite a lot in the manner that you describe. Keep wearing the hearing aids and gradually habitation will take place and your brain will focus less on the tinnitus.

    Hope this helps.

    All the best

    Michael

    I

  • Thanks Michael- I am getting there! Ps my T was completely unexpected as I have never been in noisy environments and don't much listen to any music, preferring speech. Mine was brought on the day after a major op - anaesthetic and much stress caused mine. But it is still all unwanted noise! Angela xx

  • Hi Angela - and others who might be interested - we have information about pulsatile tinnitus on our website at tinnitus.org.uk/pulsatile-t...

  • Hi Michael

    firstly thank you for sharing your what happens after habituation, I've had T for nearly two years, habituation seems miles off still.

    Do you recommend sound at night and during the day to try and train the brain to habituate ?

    I will try anything thanks Gary

  • Hi Gary. I believe that it's possible to train our minds not to focus on the T to the degree we simply don't hear it unless we choose to. I was nearly suicidal 5 years ago when I got my screech. Now I simply don't hear it unless I override my brains ability to filter it out.

    The key is to never focus on it and try to distract yourself onto other things. Eventually you realise you haven't noticed it for longer and longer periods. Take confidence in those periods.

    Also learn not to let your emotions attach to the T when you do notice it. If there are stresses in your life which may have caused it, deal with them.

    Eventually your brain builds up a filter which blocks the sound out unless we choose to listen for it (something I'd thoroughly recommend we never do).

    All the best.

  • Thanks For your posting, very interesting reading,I have a 24/7 high ish pitch buzzing sound, I have gone periods of forgetting about it but then O it's there again. To train the brain do you think that sound when trying to sleep and maybe a masker during the working day would help to habituate. Thanks Gary

  • Yes, it may do and may help reduce anxiety levels. I used waterfall sounds for a while but then felt able to wean myself off it. Be careful not to totally mask the T with though. It's the anxiety and obsession with the T which effectively 'turns up' the volume. It takes time but it's all about building on the 'quiet moments'. The brain is very clever at adapting! Trust it.

  • HI Gary,

    Habituating to tinnitus takes time and it's not something that one can forced or deliberately try to ignore the tinnitus. For a start, the brain cannot habituate to tinnitus if it cannot hear it. I will put up a post about this shortly titled: The brain cannot habituate to a sound that it cannot hear.

    Use sound therapy at night using a "sound machine" by the bedside. If you send me your email address then I will send you my article: Tinnitus, A Personal View, that has received positive feedback at tinnitus talk and you might find it helpful. It covers Tinnitus from onset, treatments and coping methods.

    All the best

    Michael

  • Have sent email, thankyou for your help

  • Hi michael, thank you so much for your explaination on habituation. Ive had Tinnitus for 16 months and have heard people talking about this but have found it a bit confusing as no one has explained how this is acheived. I wish there was a way you can be taught how to reach habituation because then you can help yourself to reach this goal. I do have periods when i hardly notice my tinnitus but thats usually when Im away from my normal everyday surrounding so i guess this is part habituation, but as soon as life goes back to normality, my awareness of my tinnitus comes back again and Id like to know how i can overcome this. I have slight hearing loss in one ear and was given a hearing aid with built in masker but Im not convinced it is actually helping and i have noticed ive got tinnitus in the other ear where i didnt before i started wearing the aide so I wonder if thus has been caused through wearing the aide. I do use sound at night to help me sleep which has been a godsend as i wasn't sleeping very well in the first few months of noticing i had tinnitus. But at least i can get off to sleep most nights. I dont leave it on all night though but as youve suggested it, i will give it a try.

    JoinIng BTA was a tremendous help and being able to chat to other people who know what youre going through has made such a difference to my perceptions of tinnitus but any new tips or advice would be gratefully received.

    Lesley

  • Hi lfa1

    Habituation cannot be rushed or forced. When person habituates to their tinnitus, they may hear it but are not bothered by it. I advise you to wear your hearing aid. If you don't your brain will increase it's background activity to compensate for the sounds your ear is not picking up from the outside world and sending it to the brain.

    By increasing its background activity the brain will also increase the tinnitus and this will make it louder and more intrusive and delay the habituation process. It might be a good idea to get another hearing test, since you have noticed tinnitus in your other ear as you may need another hearing aid.

    Use a good quality sound machine at night for sound enrichment. Oasis sound machines are the best. However, any dedicated sound machine will suffice. Set it to play throughout the night until morning.

    Michael

  • Hi michael, thanks for your advice. I do have the oasis sound machine so will keep it on all night from now on. Im not due to see my audiology/tinnitus nurse till next march but will give them a call after christmas and see what she says re hearing test for my other ear, though I havent noticed any difference to my hearing in that ear recently. But it would be worth looking into.

    Thanks Lesley ( lfa1 )l

  • What an amazing, comprehensive reply. Sadly - and not wanting to be depressing - I think my tinnitus has got louder over the thirteen years I have had it - and unfortunately my response to it has not really improved that much; maybe I am a bit more philosophical but it still affects my daily existence. Long car journeys are bad - but getting lost in hobbies (acting, cooking, gardening) all take my mind off it and I soldier on. Can I just ask what type of ear-plugs are recommended for T sufferers?

  • HI Berry76.

    I am unable to recommend any specific ear-plugs for you, because we are all different and suggest you have a word with your ENT doctor about this. However, I purchased mine from the BTA some years ago and find them satisfactory for my needs.

    All the best and thanks for your kind comments.

    Michael

  • I'd love for you to send me the document that you wrote referred to in these posts. Sounds like it's very helpful. Thanks. paolo.p.costa@ms.com

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