Avoiding Silence: Why?

As the title says.
Could silence make tinnitus worse?
I know I still react to my tinnitus and sound enrichment surely makes it a lot better. But sometimes (say, when you go to the bathroom at night) you cannot avoid silence. Is that a problem?

 

@RudyL90 Going to the bathroom day or night and it's quiet isn't going to make tinnitus more intrusive. It is prolonged silence over hours isn't good for tinnitus.
Michael

 

Alright. But why are many hours of silence bad for tinnitus?

Some days I find my tinnitus is less instrusive (today is helas not such a day) and I choose not to use masking and may have some hours in silence. Is that a problem?

 

One day in silence, a few hours of silence isn't really a problem at all. It's just that some people consciously avoid sounds because they fear that it will increase or affect their T in a negative way. Only then does silence become a problem. When you sit in silence for weeks, months and years you'll get hyperacusis, an oversensitivity to sound. This is because hearing is not a static thing, our hearing adjusts itself to the surroundings. If it's silent our brain will try to amplify sounds, if sounds are loud our brain will decrease the perception of those sounds.

Have you ever been to a concert or club and left, then to realize that your hearing is really bad and you can barely hear what other people are saying to you? This is not because you have gone deaf or necessarily damaged your hearing. It is a result of your ears and brain decreasing the perception loud sound. It takes a little time before it returns to your normal level. The opposite happens in silence. Things that are not loud can seem really loud after a prolonged amount of time in silence. This can become a bad cycle, where you isolate yourself because everyday sounds appear too loud, and because you're isolating yourself you're making the problem worse.

Another thing is those who are really bothered by their T. They too have a tendency to isolate themselves and listen to their T. T is like any other background sound. Normally our brain filters out unnecessary sounds and we don't even notice them. Silence makes it easier to detect your own T, and if you frequently listen to your T it'll become harder to ignore and filter out, hence making it appear louder. This can lead to a negative reactions such as panic, anxiety and depression.

So to sum things up... if you are not too bothered by your T or avoid everyday sounds because you fear it'll damage your hearing in some way, you'll be absolutely fine. Your T will be fine. Occasional silence will not make it worse.

 

@Elinor If I may say so. Some people with tinnitus choose not to use sound enrichment and prefer silence and that is fine. However, tinnitus comes in different levels of severity. When tinnitus is intrusive, by this I mean louder than moderate, it is recommended to avoid quiet rooms and surroundings particularly at night.

The auditory system and brain never switches off. If the brain hears silence during the night, it has the ability to increase its background activity and this will increase the tinnitus making it more intrusive during waking hours. This is the reason Professor Jasterboff recommends anyone that has tinnitus, particularly if it intrusive to avoid silent rooms and surroundings.
Using a sound machine by the bedside and set to play throughout the night until morning is a good way of avoiding silence and will help the brain to habituate to tinnitus more easily.
Michael

 

This statement I do not think I agree with. Noise exposure that leaves a person with muffled hearing is a sign of a temporary threshold shift (TTS). A TTS may recover, or, it may stay in which case it becomes a PTS (permanent threshold shift). Both a TTS and a PTS are real and observable on an audiogram. If the TTS leads to a PTS, the person's hearing ability really is diminished (forever). This has nothing to do with the "brain turning down the volume". An autopsy of a cochlea will equally reveal deficits in such cases (as compared with a non-damaged inner ear).

Even in the case where the TTS recovers may a person's hearing still be impaired. This is what has recently become known as hidden hearing loss. In this case, the person can pass a hearing test involving pure-tone audiometry as well as a speech discrimination test. But when a speech-in-noise test is carried out, then, the person may experience problems telling words apart. This specific finding has been published in recent literature such as:

• http://journal.frontiersin.org/article/10.3389/fnagi.2016.00293/abstract
  
• http://journal.frontiersin.org/article/10.3389/fnins.2016.00288/full
  
• http://dx.doi.org/10.1371/journal.pone.0162726

Regarding the temporary threshold shift from noise exposure, the cause of this is an excess release of glutamate in the inner ear. The first generation tinnitus drug aimed at treating this disorder is what Auris Medical has devised: AM-101 (Esketamine) which is an NMDA receptor antagonist that aims to block neurotransmission that would otherwise lead to excess excitatory signals. Demonstrating efficacy of this drug against tinnitus has been a challenge. One potential problem is that a necessary exposure to the drug is required to achieve efficacy. The competing company Otonomy has also created an NMDA-receptor antagonist drug (gacyclidine). Here the delivery mechanism is a sustained release exposure gel which does exactly that: exposure the inner ear to the drug over a period of time (not just 30 minutes). The efficacy of the delivery mechanism has been proven to make difference in acoustic trauma (vs. conventional steroid delivery). This can be seen in the paper released by Karger:

www.ncbi.nlm.nih.gov/pubmed/26655654

This specific paper also manages to establish the exact window of opportunity for reversal of symptoms (not to mention the mechanism of action of steroids).

 

I used sound therapy for a while when my tinnitus became worse and I was scared of it. I can say first hand, that playing nature sounds at a volume level slightly below my tinnitus, lowered my perception of the tinnitus greatly. I eventually found the noise machines and nature sounds apps to become very annoying, so I stopped using them. It scared me to hear my tinnitus at first, since I didn't want to accept that my tinnitus had gotten worse after so many years of it never changing volume. I did a lot of deep thinking about what the sound meant to me and why was I scared of it. I eventually accepted my tinnitus, got bored of being afraid of it, and got my life back again.

To me, sound machines and noise apps were keeping me from accepting my tinnitus and losing the fear. I've been reading books all day in my quiet apartment and it's not once bothered me. Personally, my T has been a lot less intrusive since I stopped noise therapy.

 

Yes - one rule of TRT is to not let T run your life...not a solution to obsess avoiding silence

 

If a person decides not to use sound enrichment at night then that is fine. As I have previoulsy explained, anyone with intrusive tinnitus it is not recommended to sleep in a quiet room as the perception of the tinnitus during waking hours will usually increase. My tinnitus varies in intensity considerably from: complete silence, mild, moderate, severe and very severe. Not many people have my type of tinnitus according to my Hearing therapsist and ENT consultant. I therefore, understand why some people that have mild to moderate tinnitus choose to sleep in a quiet room, as some of the people in this thread have chosen. I believe anyone that has intrusive tinnitus wouldn't want to sleep in completely silent room.

Many people do not understand how to use sound enrichment correctly at night, or indeed, how it is supposed to work. When we are in deep sleep that is when it performs its magic. In hyperacusis, it supplies the brain and auditory system with sound enrichment, which will help to desensitize the auditory system, closing down the auditory receptors or gateways. At the same time it helps prevent the brain from increasing its own background activity and preventing the tinnitus from becoming more intrusive during waking hours.

It is for this reason some people with hearing loss, notice an increase in tinnitus because their brain has increased its background activity in order to compensate for the sounds that it is unable to hear. A hearing aid/s will usually correct this, by supplying the brain with increased ambiance (sounds) from the outside world, the brain will no longer have to compensate for this loss of hearing and thus, turn down its internal gain lowering the tinnitus.

Although a sound machine can take a little while to get used to, if a person finds it annoying and interfers with their sleep, the usual reason is because the volume is set too high or they are using the wrong type of sound enrichment. Music for instance is not advised because it draws attention to itself. Low level nature sounds are consider the best. If it is set to a low volume level it shouldn't interfere with sleep.

I have spoken to many people who have habituated to tinnitus and stopped using sound enrichment at night, only to find, over time the tinnitus gradually becomes more intrusive. This will not happen in every case as we are all different.

Michael

 

What are the scientific evidences behind this ?

 

My tinnitus is pretty intrusive but I find sound enrichment annoying - almost as much as the tinnitus. I always sleep in a quiet room. I've found recently though that my perception of tinnitus at night is actually going down. If I listen for it it is loud but it is as if the loud T is my new silence and it doesn't worry me. I do notice it more during the day though. Weird.

 

When people say intrusive tinnitus, do they mean hear it everywhere?

 

Yes yes yes i am with you there. At night when i am going to sleep i am at my most relaxed and the t seems quieter(i sleep in silence). Throughout the day i like to have some sound enrichment on or it can be annoying. Why is this? ?!?!

 

Mine is also softer at night.

 

I too find I don't need sound playing to sleep.

 

Me too thankfully, in silence my T is almost gone it only reacts and spikes with other sounds.
I even put 3M ear muffs on today and could only hear it very very faintly.

Then after gym tonight it was literally blasting for 45 mins after

 

Yeah, I went to a work Christmas 'do the other night. Mostly women, getting drunker and louder...then the squealing starts. I was a dead-loss the day after. They all know, but their tipsy alter-egos don't remember. I usually avoid such things these days and this is why.

 

Unless it bothers you it shouldn't be an issue, i personally freak out.

You can avoid silence if you you are determined enough. Ive not been in silence since my last hearing test months ago! i avoid silence it at all costs and expense which has totally turned my life upside down. I even a a UPS battery backup in case of power cuts or the electric tripping out!

If you can tolerate silence good for you dont start avoiding it!