Will My Tinnitus Get Worse?

Will my tinnitus get worse?

I visit a number of tinnitus groups and correspond with people by email and telephone. Three questions are often asked: When will a cure be found, will I habituate, and will my tinnitus get worse?

On my started threads there are posts on habituation and how to achieve it. We are all different so the process will not be the same for everyone. Some people have a lot of difficulty acquiring it for various reasons. I have addressed the issue of when will a cure be found for tinnitus. It is just my opinion and not absolute and ask that all my posts are viewed as such. They are based on personal experience and gathering information during correspondence with people affected by this condition. It has been a learning curve and also enlightening when certain topics and questions keep occurring, one in particular: Will my tinnitus get worse? It is natural to ask this question because tinnitus can be very distressing.

The way a lot of people acquire tinnitus broadly fits into four main categories: an underlying medical condition within the auditory system, noise induced, medication or some sort of injury particularly to the head. It can also appear for no apparent reason. Again, these are examples as there are probably others. When tinnitus is caused by an underlying medical condition, medication or injury, I think it's best to seek the advice of a doctor and also one that specialises in ENT as this is their area of expertise.

Tinnitus that is noise induced will usually improve with time and once habituation is achieved, remains this way for many years. For this to happen there are a few things to keep in mind. Hyperacusis often accompanies noise induced tinnitus and comes in various degrees of severity. It can improve by itself without specialist treatment that I've mentioned in my thread: Hyperacusis, As I See It. If hyperacusis doesn't improve naturally or specialist treatment is not sought, then it can become a problem and cause the tinnitus to spike even though a person has habituated.

Reactive tinnitus is something that I don't believe in and have given my reasons. When a person habituates to noise induced tinnitus which can take up to two years from onset, with our without specialist treatment, hyperacusis is no longer a problem. Please be aware you are never completely out of the woods and need to be careful. Some people are lulled into a belief, because their tinnitus is low, they can attend clubs, concerts where loud music is played as wearing earplugs they will be completely safe – unfortunately this is not necessarily true as external sound, when too loud can pass through the head/skull and transfer to the inner ear by bone conduction and spike the tinnitus. It might reduce to its previous manageable level but can also increase to a new permanent one.

The use of headphones, earbuds, and headsets are often discussed in tinnitus forums. Many people having habituated to noise induced tinnitus return to using these devices and their tinnitus increases. It may not immediately but the risk is always there that the tinnitus could steadily increase using them even at low volume. Some people are not adversely affected by these products so the choice rests with the individual on whether to use them.

Considering how severe and debilitating tinnitus can be, my advice is to be careful of being around loud sounds and not to use headphones, earbuds or headsets even at low volumes.

Michael

 

Michael: Your post does not address tinnitus caused by age-related hearing loss, or presbycusis. I am 66 and had a sudden onset of tinnitus and hyperacusis.

Subsequently, I was determined to have high frequency hearing loss, not directly related to noise exposure. Not sure what my prognosis will be for tinnitus worsening. I am very much avoiding exposure to new loud noises.

 

@DRobi

Thank you for your comments Doug. My post is written to address tinnitus caused by exposure to loud noise, with or without hyperacusis.

Presbycusis is age related hearing loss, in your case tinnitus and hyperacusis also accompany it and there could be various reasons for this. Therefore, your hearing loss with tinnitus comes under the category of an "underlying medical problem within the auditory system". I have said in my post this needs the intervention of an ENT doctor because this is a specialist area. At some point, you may also need a referral to an Audiologist for hearing aid(s) Your Audiologist may also discuss with you treatment for tinnitus and hyperacusis.

You are correct, high frequency hearing loss with or without tinnitus is not always a result of exposure to loud noise.

I hope you are able to get the help that you need.

All the best
Michael

 

The worsening tinnitus is definitely a fear I have. I have read all of your posts, and often come back to them when I need to reassure myself that “this too will pass”. I have been using OTO - a Tinnitus CBT/ Sound Therapy app and I purchased the full plan. It seems to be very helpful and allows me to play it whenever/wherever I need. I have trashed all my headphones. Even if my tinnitus heals fully, I will not use in-ear headphones ever again, and will limit the over ears (currently I use none and it’s all on speaker).

Would you be willing to give me additional advice? I am not sure if my tinnitus is noise induced or medically induced but I would like advice on how to move forward in navigating this situation. Your advice I have read so far has been so helpful. Thank you!

All the best.

 

Thank you for your kind comments candytree82. Good to hear that you have stopped using headphones even though your tinnitus might not be noise induced. You are reading my posts the way I intended and that is referring to them often. This helps to reinforce positivity which is something that takes time to acquire, so well done. It is good to hear that you are finding the Tinnitus CBT sound therapy app helpful.

Please feel free to ask any questions and I will try to help.

All the best,
Michael

 

To Michael Leigh:

You frequently state that "Tinnitus that is noise induced will usually improve with time and once habituation is achieved, remains this way for many years."

I can state emphatically that this has not been the case with me.

Has this been empirically verifiable through some sort of clinically administered testing, or is this just based on your subjective, anecdotally received commentaries?

The very sobering fact (and I so wish that this were not true) is that such a comment has been contradicted by too-many-to-remember posters on this forum.

Doesn't tinnitus that is noise induced almost always involve tissue damage to the cilia and/or aural nerve?

How can you be so sure that such compromised organs will remain in absolutely the same state without further degeneration?

Especially when, in my case, aging involves the inevitable degeneration of such already undermined organs.

What, in fact, is there within the body that remains in a perpetual stasis? Does your blood pressure? Or your rate of heart beat? Or your cholesterol level? Or, in fact, anything?

Specifically, how can habituation have any bearing whatsoever on the possible further degeneration of such tissues and hence the worsening of tinnitus?

Are you suggesting that just having a positive outlook will somehow improve the performance of these anatomically compromised organs?

My ENT Doctor said that from the Flu I might have a virus lodged somewhere in my inner ear, and at times it can be dormant (with low tinnitus volume) or active (with high volume).

Given such fluctuations, how can habituation possibly influence what a viral particle does or does not do?

 

Short answer: it means most will habituate and not get worse if they protect themselves... but yeah I got a tad worse too.

 

When I submitted: Will My Tinnitus Get Worse? to this forum, I made a mistake and submitted an earlier draft which should have read differently. When I realized my mistake the time had elapsed for me to edit it.

Please do not alert me again, as I have no wish to correspond with you. I visit this forum to help people if possible and to not engage in arguments.

Goodbye and I wish you well.
Michael

 

Well said Wrfortiscue.

 

To Wrfortiscue:

I cannot believe in your simplistic, sophomoric interpretation of my comments.

I sometimes ask myself why I bother in an effort to be as articulate and reasoned as I can when I receive a response like this.

Such an unfortunate response will not prevent me in the slightest from asking legitimate, scientifically oriented questions whenever I feel the need for clarification.

Did it ever occur to either you or Michael Leigh that others on this Forum might have the same concerns and questions regarding such masses of orotund, confused rhetoric?

 

I meant most, not all lol. I understand some have it severe enough that nothing will help. Hopefully I understood what you were trying to say.

 

My question relates to your warning on headphones at all volume levels. I am interested in this because I love music and I love headphones. I have had noise induced tinnitus for as long as I can remember and generally speaking it has not bothered me over the past 20 years. I do try to protect my ears wearing earplugs at concerts etc. I use headphones, IEMs, and over ears from time to time but the volumes are always kept within safe zones if not lower.

I am asking because in recent months I have noticed that my tinnitus has worsened after many years of virtually no bother. I have not been able to identify and triggers. No "noise" events per se. I am struggling to cope with this new increased level of tinnitus. It's particularly bothersome at night and during the day it is manageable except for the "bad" days. I am struggling to identify whether my increased tinnitus was gradual but just needed to cross a threshold for me to notice or the result of an event such as my COVID-19 vaccine, trial of Propecia etc. It's really frustrating not being able to identify a cause after so many years of being relatively fine.

Turning to headphones, given the 2 decades or so that I have used them without much trouble, is it your opinion that I should give them up entirely? I'm willing to do so although it will cause me to give up one of my few hobby/joys in life. I exercise frequently and go for long bike rides and I particularly like to listen to music during this time (usually at the lowest possible volume setting).

I am "afraid" that my tinnitus will get worse. If it gets any worse than it is now, I'm going to need serious intervention. Right now, although worse and causing me depression, I can tolerate it by keeping busy with work, my kids etc.

Also, what is your take on sporting events. Can they be safely attended perhaps with earplugs? I would hate to have to give up football games and hockey games with my young boys.

I would appreciate your thoughts.

 

I know you didn't ask me, but I'll give you some of my thoughts, @Clerkp.

It can be difficult to pinpoint exactly what is causing tinnitus to worsen. Most often than not, the culprit is hearing loss, and there doesn't necessarily have to be a "noise event"(acoustic trauma) to trigger or worsen tinnitus; the brain can latch onto any hearing loss whether it is induced through aging or living a life in moderate to loud noises.

Worsenings in tinnitus doesn't have to be linear with the hearing loss though, as the effect can set in long after the hearing loss has actually occurred. Tinnitus can be unpredictable, and manifest in different ways.

Sorry to say it, but I'd advise you to stop using headphones entirely. There's numerous posts on this forum of people using headphones on "lowest possible volume" and still worsening tinnitus. This doesn't mean music dies; there shouldn't be a problem listening on reasonable volumes with speakers, maybe with a nice HiFi-setup. That way, the sound waves dissipate in the surroundings, and you can estimate the loudness more accurately.

I'd advise you to not go to concerts again. The volumes are just far too dangerous. A set of ear plugs won't protect from hearing damage if the volume is loud enough.

In my book, there's no worse thing than worsening tinnitus, or even worsening (or getting) hyperacusis. Take care of your ears. Better safe than sorry.

Wish you well,
Stacken

 

Hi @Clerkp.

As mentioned in my post: Will My Tinnitus Get Worse? Once a person habituates to noise induced tinnitus, it will usually remain stable for many years. The main reasons for this type of tinnitus to get worse is further exposure to loud noise or using any type of headphones even at low volume. This includes earbuds, AirPods and headset. I have also said some people with noise induced tinnitus use headphones and their tinnitus is not affected. However, this doesn't mean things cannot change.

I have corresponded and counselled many people with noise induced tinnitus and deduced, each time a person with this type of tinnitus uses headphones they risk making their tinnitus worse. If they are exposed to overly loud sounds they risk making the tinnitus worse even when wearing earplugs. The reason being, if external sound is loud enough it will pass through the head and transfer to the inner ear and could spike the tinnitus. The tinnitus might calm down or increase to a new permanent level. These are my findings. I have had noise induced tinnitus for 25 years and habituated to it twice. This is not a condition to take lightly because it can become seriously debilitating if a person isn't careful.

By all means go out to sporting events and enjoy yourself but take precautions and be mindful of loud noise. Wearing earplugs is no guarantee that a person with noise induced tinnitus will be safe.

In the near future I hope to be submitting a post on habituating to variable tinnitus. It is noise induced tinnitus that has suddenly changed and become variable.

Take care,
Michael

 

Thank you. This is scary stuff. I am terrified of it reaching the debilitating level you are referencing. Truly terrified. I don't even know what to do. With 2 young kids, there is a lot of noise and yelling in my house. My wife and kids think I'm overreacting to the hyperacusis which is also worse.

 

Thank you. Sobering and perhaps just as depressing as tinnitus itself.

Do you have an opinion on noise canceling headphones? Even for watching TV or on planes? Or bone conducting headphones?

As an example I exercise in my basement with a fan for heat. My Bose NC headphones cut the fan noise quite a bit. Wouldn't this be preferable to the fan?

 

Excellent post.

 

Can you describe what you mean by "variable"? I feel like that it is what I am experiencing. I am having good days where it seems like perhaps it is the same as it has always been and bad days where it is worse. This never happened to me before. The one constant is that it is loudest at night and lack of sleep is a definite trigger. On the rare occasion I get a full night's rest the next day is always very close to the old baseline.

 

I completely understand. It's awfully hard. But I think we should try to prioritize our ears(health) higher. And again, this isn't necessarily the end to music, it can be experienced through other setups. We can find a lot of other means of fulfillment in life, we just have to seek it.

I have never used noise canceling headphones or bone conducting ones. The fact of the matter is that some (many?) can use headphones without problem, but to me, it seems like a roll of dice. I'd still recommend to use speakers at reasonable volume for listening to audio.

Usage of noise canceling headphones for the noise cancellation may not be too dangerous. My understanding is that there's a few who use this feature on this forum. In my opinion, I'd still recommend to use some hearing protection if the fan bothers you, like foam earplugs which cause very little occlusion effect when correctly(deeply) inserted.

This is just my recommendation, and you may do as you wish with that.

Wishing you well,
Stacken

 

Hi @Clerkp.

Please bear with me, as I hope to be posting the piece on variable tinnitus and hopefully you will find it helpful. Tinnitus does fluctuate but this is quite different from variable tinnitus. Variable tinnitus can range from complete silence, mild, moderate, severe and very severe. I have this type of tinnitus but it wasn't always so. It was caused by a second noise trauma. According to my ENT consultant and Hearing Therapist, they don't see many tinnitus patients with it. I have corresponded with people that have it. Most of them have noise induced tinnitus such as myself, they habituated and then suffered a second noise trauma and the tinnitus drastically changed.

Habituating to this type of tinnitus isn't easy and is very challenging but is still possible because I have.

Take care,
Michael

 

Mine keeps getting worse. I can't take it anymore. I think I have hyperacusis. I wear protection, try to avoid loud places, don't listen to music... I think one of my biggest setbacks was the dentist. I also worsened my tinnitus from an earwax cleaning. It was water as the doctor said she couldn't remove it manually, the earwax was stuck on my eardrum. I couldn't hear anything from the left side for 24h+ until she removed it. It happened because my earplugs pushed the earwax further in AT THE DENTIST. My teeth need to be adjusted again for the third time this year.. I'll just live with the pain. I can't afford to risk worsening again.

I won't fly anymore. I have a current job offer for a dream company but it's too loud (car sales near a busy street for a luxury brand that I love, and it pays VERY well... but I'll have to turn it down after I realized it's too noisy there). My current dealership is at a less busy street, but still it's quiet inside the dealership for 90% of the day and then going outside can set me back. It sucks being good at this, knowing that I can't even sell on the phones inside for too long because my ears will hurt. I need some quiet job. But it's difficult to find something 100% quiet.

Constantly getting worse. Every single day is torture. And the first year or 2 that I got tinnitus, I didn't work. I stayed inside and still it got worse. So job or no job, it just gets worse on its own. But without a job, the added downside is extra stress due to not being able to pay the bills. So we need to work, many of us on this forum. This sucks so much.

 

I'm awfully sorry to hear that, @AVIYT.

Can you pinpoint why exactly it is getting worse? Do you have permanent spikes to low level noise constantly which raises the baseline, or does the baseline just raise itself without apparent reason?

Hoping the best for you,
Stacken

 

Thanks for the explanation. Interesting. Mine varies but not at the extremes (i.e. never silent and never very severe) but I swear I might be crazy because sometimes I am convinced it's back to my old baseline and other days it seems very loud. I can't figure out whether it's real or imagined. Actually louder or I'm focused on it. Today, for example, I would swear it's back to the old baseline. But at 2am I woke up and it was blaring over the white noise and fan. Yet when I woke up at 6am is was quiet. Is my mind playing tricks on me? I'm beginning to question whether this spike of mine is psychological. I tend to obsess over things and it's hard for me to let them go.

Anyway, I look forward to your post and appreciate the thoughtful responses.

 

This headphone thing defies logic to some extent. I completely agree with you that it's probably just not worth the risk but I am wondering what would be special about headphones versus speakers that would make tinnitus worse. Just for example, I rode my bike the other day with IEMs in. I literally had them up on the very first volume notch. It was just loud enough to give me some background enjoyment. I would guess 40 to 45 dB max. There is absolutely zero chance this volume level would be harmful to my ears unless there is something in the IEM itself that is more harmful than the actual sound. In fact, I'm sure my fan and white noise machine going all night are louder. I've read the debates here about headphones. As I write this I'm having a good day so that is probably why I'm more bullish.

I do appreciate the advice here and it is sound. I am probably going to dump my expensive headphone collection and switch to speakers. That seems like good advice. I even thing when exercising I am going to switch to using my Bose for Netflix only - no music. The one that really guts me is the bike rides about 3.5 hours a week. I may look into an external speaker but do wonder if that very first volume notch really presents a risk? It seems to me the external speaker or even bone conduction would have to be played louder whereas an isolating IEM can be used at the lowest volume.

 

To be honest, I'm not qualified to answer that. All I know is that there's quite a few posters on this forum that have worsened while using headphones on the "lowest possible volume". Why exactly that is, I do not know, and I understand where you're coming from.

One could speculate that it may be the sound waves going directly towards the ear drum, having nowhere to escape because there's a seal. Things also become complicated when there's outside environmental sounds, because then it's easy to increase the volume, not realizing that the combined sound levels might be dangerous, but that's another issue. I find it personally easier to estimate the loudness of things using speakers.

Yeah it's sad, but if I were you, I'd probably do it. I will most likely sell my complete genuine car audio system too since the road noise itself is borderline damaging, and music on top of that would not be good. We can make some good bucks from the equipment though, and get something new.

Yeah, no, I don't think that's a good idea either. How's the bike route? If there's along roads or in the city, I'd definitely use some hearing protection instead without any music. Road noise can momentarily be very loud and cause setbacks. This is just me, but I'd never step foot outside without hearing protection, unless it's a forest, but that's just me.

Wish you well,
Stacken

 

Hi @Clerkp.

The things you are experiencing with your tinnitus is not psychological but very real. The fluctuations in the tinnitus are a warning that your auditory system is being put under stress. There could be more than one reason for this. Firstly, using headphones which is not a good idea for anyone to use that has noise induced tinnitus. Secondly, the amount of bike riding you are doing might be aggravating your auditory system too. Some aerobic exercises can make tinnitus worse for some people.

Running on hard ground or on a treadmill. This causes impact under foot and travels up through the legs into the upper body, head and auditory system. Please note I said some people with tinnitus are affected by running and other forms of aerobic exercises this doesn't mean you are affected. Please do not dismiss what @Stacken77 and I have said about headphones. You are playing with fire in my opinion. There is no logic to the way tinnitus behaves or science for that matter, which so many people harp on about. Thinking everything has a scientific solution well tinnitus doesn't. Type headphones in the search box at the top of this page and read the posts.

Take care,
Michael

 

Why would bicycle riding aggravate my tinnitus? It is low impact although I certainly do it vigorously. I can't fathom giving it up - imagine the health consequences from giving up exercise? I ride on a trail that is far away from the city or cars. There is wind noise of course but that's about all.

Giving up headphones is one thing, but giving up something that is objectively healthy and good for me seems counterproductive.

I appreciate what you both are saying but at some point the remedy is worse than the problem. Has to be a balance right?

 

Wear plugs while you ride. The depression from no riding and lack of exercise is far worse than riding imo.

 

I do not wish to duel with you @Clerkp. I am merely giving you facts, that some exercises can not only aggravate tinnitus but make it worse. Continue riding your bike I didn't say you should stop. I have corresponded with many people that have noise induced tinnitus. Some have had to stop running because their tinnitus was made worse, others are not affected. Some have had to stop lifting weights or doing karate because their tinnitus increased. I use a cross-trainer/elliptical machine at home and my feet don't make contact with the floor so there is no impact.

Keeping the body fit and healthy is important and also the mind. Tinnitus is mostly mental and it can reach severe levels. If this is sustained it can be very debilitating. You have noise induced tinnitus. Ruling out hearing loss and other underlying medical conditions. The main cause for this type of tinnitus to increase is exposure to loud noise and using headphones, of any type even at low volume. Not everyone with noise induced tinnitus will be affected by headphones but many are.

A person with noise induced tinnitus can be using headphones for quite a while without any problems, then things can suddenly change. I know this from the people that have contacted me in distress with their tinnitus because of using headphones, headset, earbuds even at low volume. The unfortunate thing is, if the tinnitus increases because of exposure to loud noise or headphones, there is no guarantee it will reduce to its previous baseline level.

You might want click on the link below.

I wish you well.
Michael

https://healthfully.com/exercises-that-worsen-tinnitus-6321924.html

 

A bike ride on a trail shouldn't be much of a problem. If the noise bothers you, deeply inserted foam earplugs is great. I think there's quite a lot of people who experience spikes due to exercise, but my understanding is that it's quite benign, and not much to worry about. Spikes from noise on the other hand can be a little more scary.

Continue your bike rides, they're good for you. Just look after your ears, we live in an insanely noisy world.

Stacken