Back to Silence

If we're not taking into consideration the context of the ask, we're not going to be able to understand the nuances here.

When receiving medical care (such as the example you gave, or in ER triaging), there is an incentive to overstate your pain level because that's how you get attention faster. Doctors and nurses know this, and don't only look at your self-reported data.

In the context of scientific studies, that incentive doesn't exist.

For tinnitus in particular, scientific studies often do measure volume (through stimulus matching and adjustment for PTA losses, there's also MML/min masking level - many of us have gone through that with an audiologist). There are many studies that study correlation between loudness and distress (look for them on PubMed, example.

We can keep saying that loudness doesn't matter, and that it's how we deal with the sound that matters, but the science disagrees. It also perpetuates victim blaming ("you're not positive enough! that's what your problem is!") and doesn't encourage finding a real cure (since it really is all in your head, you're just not trying hard enough to get better).

 

The whole pain from 1-10 thing would have more value in my opinion if they calibrated your experience first. "What is the maximum pain level that you have experienced and what were the circumstances?" 10 and burn victim is a lot different than broken finger and 5. Even then it is largely subjective though. In the end I would think that the objective is to make the patient comfortable while monitoring for pain med shopping. I get that it does give them a relative reference for if they have provided adequate relief but the whole thing seems silly to me. They almost always started me off with mild pain relievers after surgery and ratcheted it up if I reported discomfort until I told them that I am good. I am sure that patients mostly figure out what the right answer is to get more drugs if they want them or manage what day they go home.

As far as tinnitus loudness goes, I think it's like pain in that the only thing that matters is "how has this affected your life", a QoL inventory if you will. If it has ruined your life then something needs to be done about it if possible because there is suffering.

My experience with such things is that it's a combination of the characteristic of the sounds (or pain) and how we react to it. The loudness, pitch, distortion, etc matter but so does our reaction. I agree that there is far too much dismissal and assumption that anyone who suffers is just weak. That's ignorance assuming that an illness with an emotional component is not legitimate or that the patient is therefore not worthy of attention. In the end doctors are people and a lot of people are assholes. On the other hand, I see a lot of resistance and push back from patients to work diligently to improve the emotional management of the beast. I started learning about this in the 80s with chronic back pain. Guys like Dr. Sarno did say that it is largely in your head BUT he acknowledged real suffering and spent his career helping people to get better not send them home and tell them they are weak. He would reject them for treatment however if the patient would not accept his premise and want to work with his methods. He had a very good track record, in some cases complete cure for people that in some cases were told that the only option was surgery. Not all but most. Part of getting older is managing the accumulation of injuries and wear out mechanisms so yes, any actual reduction in sounds would be wonderful and a big help but as in most ageing conditions, we have to learn to manage them because many will never have a complete cure. I have many of these myself.

As far as research goes, there either is a profit incentive or there is not and I do not live or work in that space so I don't know the financial dynamics of tinnitus and research. In research I am sure that a calibrated measurement of volume and characteristic is necessary to monitor progress and cause/type but I am sure that there are people at high levels of volume that don't care and the converse is also true.

Does the fact that asshole doctors exist who imply you're weak and send you home to live with it prevent research? I'm not convinced. If it's profitable, they will come. The actual numbers that suffer without relief, the so called 0.1% club, may not be big enough to warrant big research dollars. That's no comfort for those suffering without relief but business is business. The billions in research dollars get handed out largely on presumed ROI. SSRIs and anxiety meds work completely on shit that's in your head but it's big business.

George

 

Okay, so yours is 24/7 loud tinnitus too. I just seem to always hear mine so I'd have thousands of lines on my piece of paper as it is ever present.

 

Try starting off with your initial emotion and then when it changes write that down or if its always the same for now, maybe every hour or two.

George

 

This is an amazing post! I will try this. I hope it will help me.

 

So... I realized Back to Silence works but if your tinnitus is reactive, you may push through and keep pushing through noise... and get worse lol.

 

I guess just do the Back to Silence regimen while also being proactive about your tinnitus not getting worse.

 

This is it.

 

Does this also work for loudness hyperacusis/dysacusis? Like don't let the things stress you and help accept it.

I am two months in with the new symptoms and they make me feel like nothing matters anymore.

 

Here is something I posted on this topic on this thread in the past that might be useful:

https://www.tinnitustalk.com/posts/625600/

 

Hi again. I think it's been 6 months since my last post here.

I have a spike this week, and it's 5/10.

I have used Back to Silence method for 10 months and I have weeks, even months when I don't think about my tinnitus.

It just works for me. Don't give up and it will result in a better life quality.

 

Hello everyone!

It's nice to see the folks here having good results using the method.

Today I was awarded a nine year trophy for my attendance here on the forum.

I don't check in here much anymore, please forgive me, tinnitus isn't on my mind anymore... thanks to the method.

Good luck, see you later.

- I who love music

 

Congratulations on the 9 years. Thanks again for sharing your successful strategy.

Regards,
Phil

 

@I who love music, a success story is always valued! Glad you're doing great!

 

Hi there,

My tone is so high pitched that I hear sound distortions all the time. So when I try to distract myself with music, podcast etc., I hear the „ssss“ with every sound.

How can I use the Back to Silence method to overcome my tinnitus? I’d really love to move on and get on with life...

 

The "Back to Silence" method calls for not measuring the sound(s), not to monitor the tinnitus sound(s) or focus on it, do not describe the sound(s) or compare the sound(s).

Another way to think about it is to follow the four "don’ts" of the Back to Silence method:

1 - Don't measure it.
2 - Don't monitor it.
3 - Don't describe it.
4 - Don't compare it.

Do the following:

1 - STOP talking about tinnitus, measuring it, comparing it, describing it, and thinking about it.
2 - When you hear the sound(s), tell yourself, "I hear it, I feel .........." (insert your true emotion).
3 - Make a note of this incidence (just put a hash mark for instance and add them up daily. The total will go down over time) and each emotional response in a word or two on paper is best, review your paper weekly to see the change in your responses.

Once you get to less than 5 or 10 incidences per day, you can stop writing them down and only do it in your head since you do not have to speak it aloud to get the result.

If you don’t want to write it down, that is OK. Give it a try just verbally and see how it goes. If you do not notice a decrease in incidences over time, then begin to write them down to keep a count, even if it is only a hash mark to keep the count.

 

Thanks. I was asking especially in regards to the hearing distortions.

 

Could you also use the same process with the sound distortions? Maybe like: "I hear a sound distortion, I feel... insert your true emotion" when they show up in your consciousness?

 

What about when you hear tinnitus 24/7 and think about it 24/7?

 

You would not be the first person who has asked about this type of situation so just know that. Of course as you know there are no guarantees in using this approach. I am reminded of a quote that goes like this: Pain is inevitable. Suffering is optional.

If all the approach did was reduce your suffering somewhat that would be a good thing. You have nothing to lose by giving it a try I figure. My recommendation in a situation like you seem to describe is pick some time frame, e.g., every 15 minutes and then just say "I hear my tinnitus and I feel XXXX now." That is if you hear it of course. Maybe at some point you discover you are not hearing it at the time you check in. Then make a hash mark on a sheet of paper with a one or two word description of your feeling. Thus you would be noting 4x per hour, not every second. See what happens with that. In other words, experiment with it a bit. I am not "the expert" on how to do this. I am just a happy user of the method who reduced my suffering by getting higher up on the scale of habituation.

Here is a document that lays out a model that shows the 4 stages of habituation, provided by the American Tinnitus Association:



I hope this is useful. Others on this string might have even better ideas than I to address your question.

 

@Henry Orlando FL, it's interesting that the 4 stages of habituation were published 1989. They are still the same today.

 

Interesting... I did not know that. When I got mine in 2011, I had a very hard time finding anything about tinnitus online. Now, there is a ton of information which is a good thing on balance I figure. Even with the poor information often given with good intent and the scammers that are out there, I figure it is a good thing to have a ton.

 

I developed tinnitus in 1989. The tinnitus was slight but I saw an ENT. This is before the internet. I didn't ask the right questions. I assumed it was part of aging. In 1990, after I went to a wedding, my tinnitus zoomed up! I went to the local library which had three books on the subject tinnitus. Bam, most common cause mentioned was noise exposure. The ENT never mentioned noise exposure! I found a reference to the American Tinnitus Association. Subscribed. Kept my subscription for a few years, but after reading the same information over and over again, and when the internet arrived, I stopped subscribing.

 

The other day I experienced something that made me think you can habituate to even loud tinnitus.

My girlfriend's scooter, when it's being charged, does a really loud beep noise which is very intrusive and bothersome, like a 12/10 type of noise.

It bothers me a lot but I started watching a movie and at one point I was not able to hear it, my head blocked that freaking loud beep that is a lot louder than my tinnitus.

The problem is that convincing our brain that tinnitus is not our enemy is very difficult to accomplish.

 

I know what you mean @NYCGuy. I’ve experienced moments where I’m completely oblivious and unaware of my tinnitus when I’m doing some sort of activity. Granted, these moments only last like 1-2 minutes tops, but if there was a way to harness this ‘blocking’ mechanism for more longer durations, then it would be amazing.

It’s like when people put clothes on. You can feel sensation from the clothes when it touches your skin, but we’re able to put that sensation in the background and not be aware it. I would love to achieve that if it’s possible, but tinnitus severity makes it way more difficult however. I think it’s possible. Definitely need a mind for it.

 

I feel you so much. Every time i'm at peace with my tinnitus, after a while it acts like a constant enemy. Like 'i don't want you to feel good'. It's exhausting.

 

I’m curious, when you habituate to loud intrusive tinnitus like @I who love music did, when you lie down at night in a quiet room, does the brain just filter it out? Or can they just push it to the background of their thoughts?

 

I would not use the term "push it to the background" if you will. For me with what I consider moderate tinnitus, I become aware of it when I become aware of it and I don't when I don't. Either way it does not bother me. When I do become aware of it, I just say to myself "I hear my tinnitus and I feel X." I do usually become aware of it in the morning upon awakening and upon going to sleep at night. I also might go days without becoming aware of it during the day or some to many days I become aware of it 2 or 3 times during the day and I just note it to myself in the usual way. It is not different than any other body function to me now. It comes around when it comes around and is not in my awareness when it is not around.

Here is a model of the stages of habituation that might be helpful to you:

 

First of all, thank you for your detailed response, I do appreciate it.

I’m interested to know, what do you classify as moderate tinnitus and would you say your initial reaction to it drove it to a severe level?

Thanks.

 

Just stopping by to say that I am remaining hopeful with you!