British Tinnitus Association
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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

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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

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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

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

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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

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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.

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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

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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.

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I'm going through this process at the moment. I have the sound of a shower running on all the time. Is it not a good idea to use it all the time?

Also due to my anxiety is taking medication a good idea? Thinking of taking anti depressants anyway.

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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

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Can you send it to me please Michael

Redcar.boys@gmail.com

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Have sent email, thankyou for your help

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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

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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

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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

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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?

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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

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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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Hi Michael, I read your post with interest; got Tinnitus 4 months ago; I am back to back to work since 3 weeks. I would appreciate you could send me your article. Best, Ivan. Ivanmilliau@hotmail.com

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HI IvanMilliau,

Good to hear that you are back at work. I will send you my article.

Take care

Michael

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Hi, I had a big spike 10years ago had got use to the sound and it was under control. Recently I got an ear infection which has spiked it again. Is it possible it will settle again like it had before? Also can you send me the article too, thank you. Stefanburt@gmail.com

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Once your ear infection has cleared up/gone your tinnitus should return to its previous level. If your tinnitus was caused by "loud noise". Then I advise you not to use headphones even at low volume. I also advise that if you go to places were loud music is played be careful and use earplugs (noise reducing type). However, please be aware that wearing earplugs doesn't mean you are safe you still need to be careful and this is the reason:

If external sound is loud enough it can pass through the skull and be transferred to the inner ear and irritate the cochlea and could make your tinnitus worse.

Michael

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Hi,

Thank for the email and message. Truth be told I've found this incredibly hard to handle and I've been googling like crazy but most of the things I've read have been terribly upsetting stories. I saw a nurse yesterday who found water on my ear and said it was causing my T, but my mental attitude is that this is going to turn out bad and I'm just not hearing it correctly, well apart from the tinnitus ;)

Is it quite common for T to spike in periods of infection and then just go back to normal?

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Everyone is different but an ear infection can cause a person to get tinnitus. It can also make tinnitus spike in a person that already has the condition. After the infection as cleared up your tinnitus should return to its previous level. However, this could take some time after the infection has gone so be patient.

Michael

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Thank you for this! It is the most (maybe only) encouraging thing I've read since I got T. It's only been about 6 weeks, but has been a great struggle at times. The most upsetting part is when it seems I'm making progress and it seems to be quieter for longer periods, only to have it return during the evening, while sleeping. And throughout the next day. It seems my progress is two steps forward one back. Based on your writing, I believe that may be part of the habituation. Maybe I just need more time. It's amazing that neither of the two ENTs I saw mentioned anything about it. It's as if they don't want us to know that's how it works, because that awareness may stall habituation. Thank you again. I finally have hope. If you would please send your article to wllpdll@gmail.com, I would also be very appreciative.

Cheers,

Will

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Hi Michael,

I would love to read through your article. Could you send it to cubitt1991@live.com.

Thanks in advance and best wishes!

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Hi Michael,

thanks for the post, really well written and inspiring.

Would you mind sending me the article you are talking about?

I have gotten my T bout a month and a half ago, srsly no idea what has caused it; no loud sounds exposure on the days when it came, but a big and stressfull period had just ended and when it ended I started hearing the T... Does this make sense to you?

I've been to the ENT and audiologist and looks like I have no hearing loss?

Over the month and a half since I have it I've gone through epizodes of either being very down or anxious, but am fighting it through socializing and doing sports. Although this also gets hard sometimes. I notice I am getting bigger "chunks" of the day when I dont think about it, so I guess I'm on the right track?

The volume itself I dont think has changed much throughout the time I have it, maybe it went down a bit because at start I was afraid af.

Most of the time through the day I dont hear it, I hear it when I get home and its quiet, and when I'm in bed. Having some troubles falling asleep and waking up in the middle of the night, then again hard to fall asleep.

Sorry for the long post, but kinda my question would be, do I need this expensive sound enrichment? Right now I'm using some meds that the doc prescribed (rivotril). It makes me sleep fine and allegedly should help reduce the T as well.

I was thinking of going and finding the frequency of my T and then notching some white noise at that frequency (for one octave). Then, I would force myself to listen to this overnight and throughout some hours of the day. Would this work?

Again sorry for such a long post, but would be really grateful if you would take time and answer me, I registered here just because of your post.

Sincere gratitude.

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Michael, I would also like to read your document. Is there anything specific on pulsatile tinnitus, in particular help from hearing aids as well as habituation? My e-mail is plisecki13@comcast.net. Thanks in advance, Peter

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Michael, thank you for taking the time to write this article. It explains this issue of habituation so well and answers so many questions I have surrounding my tinnitus and decreased sound tolerance and you’ve also made me realise the importance of sound therapy whilst sleeping. My tinnitus was caused by loud noise exposure dancing near a speaker in a nightclub some ten years ago (I had a hearing threshold shift on exiting the club and the tinnitus has been there ever since) Once the tinnitus had initially habituated (without any use of a device or sound therapy) it was not bothersome (could block it out mostly except for quiet places and whilst in bed) but over the last five years my tinnitus has spiked at regular intervals and spikes have become more and more frequent and lasting longer and longer. I have tried through a process of elimination to work out the cause of the spikes which can be accompanied by earache and worsening of hyperacusis until symptoms have calmed down again. After much research, I am thinking (with your comments about headphones) that my job may have something to do with it as for the last five years I have worked as a customer service advisor in a call centre wearing a headset all day, every day, five days a week. More recently, I have found increased intolerance to noisy environments and when wearing a headset at work, if someone on the other end of the phone presses a button on their mobile and a beep comes into my ear via the headset (one ear headset) this causes me symptoms of earache, an increase in the loudness of the tinnitus on the affected ear and then I can develop worsening hyperacusis whereby I can’t stand normal sounds - especially high pitched noises - like my friend talking next to me, the sound of crockery emptying the dishwasher and at some points my own voice. At these times I wear ear defenders but have read this can make ears more sensitive to noise in the long term. I have used various forms of hearing protection since that initial exposure to protect my hearing so would say, as my tinnitus gets louder after exposure to loud environments, I have ‘reactive tinnitus’ caused by not knowing I had some decreased sound tolerance until now due to the loud noise exposure. It is also worth noting that the only other thing which may have added to this is withdrawing completely from anti-convulsants (carbamazepine) which I took for over 20 years for epilepsy. I am completely off tablets now and have been for two years nearly now but I am also wondering if this may mean I can hear my tinnitus more now as I have read some anti-convulsants can dampen the tinnitus volume. I must also note my Audiologist advises that my hearing is better than perfect and that my ears are hyper sensitive especially my left ear. Normal reading is around zero I believe on a hearing test, but my ears especially the left are around -10. Like the hearing of a child as described by my Audiologist. I am wondering if this might be due to no treatment for years living with tinnitus/hyperacusis. I am also thinking not using any sound therapy might be making my tinnitus worse and my spikes last longer; I often find my tinnitus is loud at night in a quiet bedroom but can be even louder on awaking and I could never understand this (I thought I might be clenching my jaw at night making it louder) but your theory about the tinnitus getting louder purely in the absence of noise/silence makes a lot of sense.

Questions:

What do you think of my scenario /discussion above? Any thoughts?

Do you think wearing headsets could make my tinnitus worse regardless of beeps/acoustic shocks? I have requested an acoustic shock protection device to limit volume and shrieks to my headset/ears but haven’t received it yet so hope this helps me. Should I be looking to stop headset use altogether or do you think this device may help me?

Could you please recommend a sound enrichment device for me to use at night. Please post me a link

Could you also please post a link to your article in your reply / here for all to see.

Any advice or thoughts you may have on my situation or experience would be most welcomed and appreciated.

I look forward to your reply and to reading your other article.

Thanks again for taking the time to write this one.

Many thanks

Sarah

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HI Sarah,

Sorry for the late reply but I have just seen your post!

I have corresponded with people that work in call centres and use headsets for most of the day, and unfortunately most have complained they have tinnitus as a result of wearing a headsets. I tend to agree with this but this is just my opinion and I have no medical proof to support this.

It seems you do have hyperacusis and this needs to be treated by self help or seeing a Hearing Therapist or Audiologist that specialises in the treatment and management of tinnitus and hyperacusis. Please read my post: Hyperacusis as I see it. Please click on the link below.

I have written an article: Tinnitus, A Personal View. It is too long for this forum. If you would like a copy, then please send me your email address by Private messenger. It covers most aspects of tinnitus when caused by "loud noise" When meeting a ENT doctor for consultation, different treatments and coping methods.

Michael

healthunlocked.com/bta/post...

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Thank you so much for your reply and advice Michael. I will messsge you my email for the article. Many thanks again. Sarah

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