How Can You Habituate to LOUD Tinnitus?

Does anyone have any suggestions for habituating to loud tinnitus?

I don't care to hear from anyone with mild tinnitus that can only be heard with ears plugged in or masked by fans. I'm talking about truly debilitating loud tinnitus that never stops.

I've been off work for six months today and have given up that any ENT, audiologist, or medication can help. I'm truly miserable, but have an advanced degree and refuse to sit around the house any longer waiting for change. I can sleep at night with sleeping pills, alcohol, or THC but functioning during the day is hard.

I'm going to look for a desk job but I need to figure out how to not hear this noise or let it drive me insane while I try to focus/concentrate.

To members whom have habituated, do you just take Xanax every morning and force yourself to work? I've exhausted all my options and been told there is nothing more that can be done. I have low and high frequency hearing loss. Above 10 kHz is gone completely and severe distortion in low frequencies from Meniere's disease. The tinnitus is constant roaring at 450 Hz at 70 decibels according to the evaluation I had today. Other tone is 10 kHz at 55 decibels.

I was hoping for Sac Decompression Surgery or a cochlear implant but was told I qualify for neither today.

Any input is appreciated.

 

There are no people habituated to 70 dB tinnitus.

 

HI @Jrblovsky

I have tinnitus for 24 years habituated to it twice and it was most severe between 2008-2012. It is now variable in intensity: completely silent, mild, moderate, severe, and very severe. I have had TRT twice the full treatment and not a scaled down version of it. Each treatment lasted 2 years and with counselling and wearing white noise generators for 2 years. I also counsel people with noise induced tinnitus at various forums, by telephone and email. Please click on the link at the bottom of this post and read article: My experience with tinnitus.

I have mentioned the above to make you aware that I know what I'm talking about when advising people on Noise induced tinnitus and hyperacusis. These are my areas of interest and like others in this forum know about them in-depth. Therefore, I hope you find my advice helpful.

I understand how you feel towards your ENT doctor and Audiologist but there are the best people to help you. You may need to change practice and see an ENT doctor more importantly an Audi0logist, that specialises in tinnitus and hyperacusis management and treatment. ENT doctors treat underlying medical problems within the auditory system that causes tinnitus. Most do not specialise or treat Noise induced tinnitus which is what you have. You should be under the care of Audiology and see either a Hearing Therapist or Audiologist that specialises in Noise induced tinnitus.

Treatment may require: counselling, sound therapy, medication, relaxation therapy or a combination these. I advise that you don't use any form of headphones including noise cancelling, earbuds or headset even at low volumes. During the day and especially at night, use low level sound enrichment. More about this is explained in the links below. Please do not try and mask the tinnitus. Keep sound enrichment slightly below the tinnitus.

Please click on the links below and take your time and read my articles thoroughly. I know this might be difficult since your tinnitus is intrusive but please do not skim through them or read them on a phone. Read them on computer screen and if you have a printer, I advise you print and refer to them often as they are a form of counselling. This will help to reinforce positive thinking.

Hope you start to feel better soon.
Take care

Michael

https://www.tinnitustalk.com/threads/new-to-tinnitus-what-to-do.12558/
https://www.tinnitustalk.com/threads/hyperacusis-as-i-see-it.19174/
https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/
https://www.tinnitustalk.com/threads/acquiring-a-positive-mindset.23969/
https://www.tinnitustalk.com/threads/tinnitus-and-the-negative-mindset.23705/
https://www.tinnitustalk.com/threads/the-habituation-process.20767/
https://www.tinnitustalk.com/threads/what-is-trt-and-when-should-it-be-started.19024/
https://www.tinnitustalk.com/threads/what-happens-in-trt-sessions.18195/
https://www.tinnitustalk.com/threads/can-tinnitus-counselling-help.22366/
https://www.tinnitustalk.com/threads/medications-and-tinnitus.12365/
https://www.tinnitustalk.com/threads/tinnitus-and-mental-health.21978/
https://www.tinnitustalk.com/threads/my-experience-with-tinnitus.12076/

 

I was hoping. But I kinda figured that. Some days it does go down in volume being I can hear the 10 kHz tones and not the roar, but it changes all the time for no reason.

 

Hi Michael,

Thanks for the response. I had hyperacusis when this started but it went away about two months in. I agree with the noise induced hearing loss, but the cochlear hydrops is definitely causing my low frequency tinnitus. I have been told by multiple doctors that cochlear hydrops can or cannot be noise induced. Sounds like they just don't know. I have tried noise generators and hearing aids. I may try again being I have nothing left to try. It's honestly pathetic that this problem is so debilitating and nothing is being done to cure it.

Do you have tinnitus in both ears or just one?

I've always wondered if for TRT I need two generators or one being I have no impairment or tinnitus in my left ear.

 

My take:

I don't believe there is any method to habituate to really loud tinnitus. Either you get used to it over time or you don't, and this may depend largely on your personality. What's left, if you haven't gotten used to it, is to cope - which is no different from learning to live with other great losses. In other words, the next step after "No, I'm not getting used to this" is "How do I pursue meaning through an existence which is actually quite painful?"

That said, there are two alternative things which may or may not be an alternative in your case:

1. Stem cell therapy. Very expensive and no guarenteed results. There are plenty info on this forum you can read up on. Focus on the posts written by the user @attheedgeofscience.

2. Meditation training that counteracts the negative medical aspects caused by tinnitus related stress. This path won't take your tinnitus or suffering away, but might make it possible for you to function without using drugs. I am a meditation wonk myself and have written a thread on how people who suffer from tinnitus can go about it:

https://www.tinnitustalk.com/threads/meditation-practice-to-deal-with-tinnitus-suffering.8165/

(In short, use meditation methods that involves a focus on the whole body and apply a fanatical commitment. While it's possible to obtain positive effects from meditation despite having severe tinnitus, this gain comes at the expense of great effort.)

 

Hi @Jrblovsky

My areas of interest are tinnitus and hyperacusis caused by exposure to loud noise. I say this because I have many years experience in them although my severe hyperacusis was cured in 2 years using white noise generators as part of TRT. I am not a doctor this is the reason I only advise on Noise induced tinnitus and hyperacusis. As previously mentioned, most ENT doctors do not specialises in Noise induced tinnitus or hyperacusis as this is not their area of expertise - to treat these condition one has to be referred to Audiology and be under the care of an Audiologist or Hearing Therapist that specialises in noise induced tinnitus and hyperacusis.


Some people are under the impression ENT doctors don't know much about the ear and tinnitus but this is not true. ENT doctors are physicians that specialise in Ear, Nose, Throat. They treat underlying medical problems associated the ear - when things go wrong tinnitus can sometimes develop. However, they don't actually treat the tinnitus especially noise induced.

You have mentioned cochlear hydrops. My understanding is that this condition is associated with Menier's. Therefore, it's probably the Menier's that is making your tinnitus worse. On reflection you may need the advice/help of your ENT doctor as this their are of expertise.

Please read my post in the link above: My experience with tinnitus. I have tinnitus in both ears but no hearing loss or other conditions.

Michael

 

Many people report feeling better/habituating after about 2.5-3 years.

 

The only thing that has helped me is time and drugs to help pass the time. My tinnitus is very loud and very high pitched. Nothing masks it. The first 3 months were horrible. I was suicidal, frustrated, all that. However, after the first 3 months my suicidal thoughts suddenly eased up. I think my brain just said well you can’t beat it, so you better get used to it. It wasn’t quieter, and I don’t like it, but I just woke up one day and could experience it without wanting to put my head thru the wall. After that I started to experience a day here and there where the volume lessened and I could function without noticing it. Then there were more days. At this point, I have gone up to 2 weeks where I can function normally during the day and can sleep 6 to 7 hours at night.

However, eventually it spikes again for some unknown reason. Since I can’t mask it, I have to be constantly active on those types of days. Because, as soon as I sit down or try to do something quiet I get frustrated and impatient with it. I know if it’s really bad I can always relax myself with some drugs (Benzos, sleep meds, or CBD) and on the worst days that’s what I do. It’s helped me to get thru the worst. It’s not ideal, but at least I’m not suicidal, and it gets me one day further in the journey.

 

While we are all feeling your pain I don't agree with "It's honestly pathetic that this problem is so debilitating and nothing is being done to cure it."

There is so much in the pipeline it would be a pity (for lack of a better word) if you would give up at this time.
I know it's hard, but hold on just a little bit longer until any of the meds or devices that are currently in the last stages become available.

Just imagine you give up now and within a year FX-322 would have been available and it would have cured (or seriously reduced the intensity of) your tinnitus. That would be such a pity.

I know it sounds shitty - but hold on, try to accept, try to convince your brain that this sound has always been there and it doesn't harm you. I know it's easier said than done - I'm still trying to figure this out myself.

 

It's your take, and I respect that, but I do not agree however. But I agree there is a certain degree of personality as well involved in this. But every case is so different, so it's impossible to really tell how others feel and react - no matter how loud your tinnitus is.

And really, getting used to it and habituate relates a lot to each other.
I know several with severe tinnitus that still live a normal and happy life - and that got used to it and thus habituated over time. But as said, we are different, and tinnitus (+hyperacusis) comes in so many different shapes and varieties.

I do 100% agree with @Ben Winders. There is always hope.

 

I found a sound that is about the same frequency as my tinnitus so I use that when I'm at the computer or reading at home. At work, playing this sound is not an option as I'm not wearing headphones, but sometimes I do play it if no one is around. I plan to get maskers next year after I change my insurance which should help pay for a portion of the cost. I think if you find a sound that is the same frequency as your tinnitus, your tinnitus should blend with the frequency sound where you won't notice the tinnitus as much. Sometimes I'm in denial and don't use sound enrichment, but I'm better off using it and always regret not using it earlier.

 

I know someone with moderate/severe tinnitus who described her sound as a flute sound. She plays Asian drum type sound enrichment so it goes along with her flute sound. If you don't like frequency noise, you can trying another type of sound that blends with your tinnitus.

 

I'd try meditation that focuses on the sound. Since it can't be masked, it seems like the best course of action is to tackle it head on and desensitize yourself to it as much as possible. I know that's may not be ideal, but maybe it can keep you together long enough for real treatments to come to market. This is how I approached my unmaskable tinnitus. Now I can sleep in a quiet environment, no white noise at all. I can also work without it bothering me. I honestly can't tell anymore if it has gotten quieter or if I'm just more used to it. I think it's probably the beginning stages of habituation.

 

I'm just going to get straight to the point because I am typing on my tablet. My tinnitus is super loud, never been masked, never will be. High pitched screech in my head.

1. Accept it's not going anywhere. Neither are you so you have to live with it.
2. Keep busy. Do any activity that helps, don't avoid doing anything you need to.
3. Stop Googling and looking for a cure. There is no cure and there probably never will be. Certainly not in our lifetime.
4. Stop whining about it. It won't help.
5. Lie to anyone that asks about your tinnitus. Tell them it's better. Lie to yourself and tell yourself it isn't bothering you anymore, or at least as much.

 

I'm trying to do that but it's so intrusive that sitting 30 minutes paying attention to the noise is extremely hard. I'm super restless. Fully watching the breath is impossible, the attention is on the noise that cannot be ignored, 30% breath awareness vs 70% tinnitus awareness. I try to move all awareness to the tinnitus but trying to sit with that is torture. I have been doing it 30 minutes every day for two months but my progressive worsening is making it harder and harder. I think mindfulness, unless you are the Dalai Lama, cannot work with catastrophic tinnitus. But that's just another thought.

 

How do you know they have severe tinnitus? How would you classify severe tinnitus?

 

@dan

The severity of it has a lot do with subjectivity really. But even so, if someone describes their tinnitus as loud as a jet engine in their head, I'd agree that would be objectively severe.

My point is that whatever type of tinnitus you have, there is still Hope and possibilities to live normally with it - and with time possibly habituate.

 

There is no way to measure tinnitus loudness accurately, but there may be a way to measure the severity using fNIRS (functional near-infrared spectroscopy). This is cutting edge stuff and you’ll hear more about it soon on the Tinnitus Talk Podcast.

I’m not trying to be disrespectful here, but there’s no such thing as 70 dB tinnitus and there are many reasons for this which I have gone over in the past.

 

Your medical source for this affirmation is?

 

People can say all kinds of things and mostly they tend to exaggerate tinnitus because it's all in our own heads and nobody else can hear or measure it objectively.

 

I could write an essay on this issue based on my knowledge of psychoacoustics, sound (I’m a trained sound engineer), and how tinnitus loudness tests work.

I’ll copy and paste the last time I talked about this issue below rather than reexplain it all. You can medically verify what I’m saying with an expert:

Pete, there’s no such thing as 70 dB tinnitus. You have to realise that there are many different weightings of the decibel scale and none of them really convert into something that can accurately measure how loud one’s tinnitus is. There is the A weighted scale which is aligned to the strongest frequencies within the human hearing range which is most notably 500 Hz to 8 kHz. Then there is the C weighted scale which takes in more of the lower and higher frequencies of a broadband sound. The Z rated scale is flat and measures all frequencies evenly.

The closest thing we have to measuring tinnitus is what’s called a pitch and loudness match.
In audiology, you will see terms such as sensation level (SL) and hearing level (HL). Remember that the decibel scale is all relative to the quietest sound that can be heard, so when one has an audiogram and their hearing threshold shows 0 dB HL, this means they can hear the quietest sound that an average human ear can detect (assuming one has normal hearing and one is relatively young). This is where the HL standard is derived. Sensation level, on the other hand, is the measure of the intensity of an auditory stimulus above one’s threshold at a given frequency. During a loudness match, the audiologist will find out at which frequency a persons hears their tinnitus - if it’s tonal - and then they will measure the distance between the loudness of that persons tinnitus and the threshold of their hearing. So for example, if a person hears tinnitus at 6 kHz at 40 dB and their hearing threshold at 6 kHz is 30 dB HL, then that person would have a tinnitus match of 10 dB SL.

One of the problems with this method is how accurately people can match their tinnitus to a frequency as there is often an octave error in one’s judgement. This is especially true of people who have no musical training. The other issue with this is that it doesn’t account for the brain’s emotional processing of the sound which is the domain of Psychoacoustics. All sounds are not processed equally, and the volume we “hear” something at is the result of a complex chain of events within the brain. The more threatening a sound is perceived to be (which is based on our life’s experiences) the louder it will be portrayed in our conscious awareness. You also have to factor in tiredness, adrenaline and other hormones, and many other factors. A great example of this is how a movie at the cinema is perceived as loud, but if someone so much as whispers, it can be annoying because it can be heard. The whisper that’s heard in comparison to the volume of the movie is considerably quieter and yet people still hear it and get annoyed by it. Another example is how we can have our car stereo set at a comfortable level, only to find that it’s LOUD the following morning when we are tired, even though nothing has changed. We often have our TV’s on quietly at night, so as not to wake others up, and yet our brain can easily normalise this level of sound to be perceived as being louder. You discover this when you come to watch the following day and it’s WAAY too quiet, so you turn it back up again.

What I’m saying is that our perception of sound is malleable and can change depending on the conditions we are hearing something in. A 20 dB creak in the middle of the night can potentially sound deafening if you are home alone.

From a Psychoacoustics point-of-view, two sounds that are the same on a decibel meter will not necessarily be perceived as being the same loudness, and for this reason, a new unit called the phon was created. A phon is equal to a decibel at 1 kHz, so 40 phons would be the same as 40 dB at 1 kHz. A 90dB sound at 150 Hz, for example, would not be perceived to be as loud as a sound that is 90 dB at 3kHz, so by using phons we can try and keep one’s perception as neutral as possible. Sones are a linear representation of phons; 1 sone is equal to 40 phons and every 10 phons thereafter would represent a doubling in perceived loudness. This means that 50 phons would be equal to 2 sones and 60 phons would be equal to 4 sones, etc. Psychoacoustics is the science of how our brain interprets sound, and it’s interesting to note that phons and sones are the primary units of measurement. This is because it’s particularly difficult to define how loudness is perceived from one individual to another and these are likely the most neutral measurements we currently have.

This is already a long post, so I’ll conclude by saying that most people’s tinnitus is around 10 dB SL when using the pitch matching method. It’s extremely rare to see anyone go above 20 dB SL.

 

Since you asked for a link of some sort I did a quick Google search to see what I could find and this seems to condense a lot of what I said into one report. I’ll post the abstract below:

Abstract

This report reviews research from the 1930s to the present that has extended our understanding by investigating the characteristics of tinnitus that can be studied using psychoacoustic techniques. Studies of tinnitus masking and residual inhibition began in the 1970s, leading to the therapeutic use of tinnitus masking and a consequent increase in research devoted to tinnitus measurement. In 1981, the CIBA Foundation symposium on tinnitus advocated general adoption of four tinnitus measures: (1) pitch, (2) loudness, (3) maskability, and (4) residual inhibition. Since then, psychoacoustic research into all four topics has proliferated, yielding many valuable insights and controversies concerning the details of measurement techniques. A consensus has emerged that neither the loudness nor other psychoacoustic measures of tinnitus bear a consistent relation to the severity or perceived loudness of tinnitus. Nevertheless, quantification is needed in clinical trials of proposed treatments and in a variety of other types of tinnitus research. Standardization of techniques for specifying the acoustic parameters of tinnitus thus continues to be an important research goal.

Read the full report here:

https://www.audiology.org/sites/default/files/journal/JAAA_11_03_03.pdf

https://pubmed.ncbi.nlm.nih.gov/10755810/

 

Even if it were possible to measure the loudness of a person's tinnitus (which it isn't) it would be meaningless and I've explained the reasons many times in this forum.

It is all to do with the way the tinnitus affects a person's mental and emotional well-being. The condition is intrinsically linked to our thought process which is an integral part of the limbic system in the brain, and cannot be separated from it - in short, it is here the tinnitus signal lives. This is the reason stress can have a major impact on tinnitus and therefore, one should try to keep stress levels low.

I have corresponded with people that say their tinnitus is mild, yet still find it troubling even after having it for a considerable length of time. Others that have it mild say they're able to go about their daily affairs without a problem. The same can apply to those that have it moderate. The reverse also happens with some people.

The following will not apply to everyone but for those having difficulty coping with tinnitus, treatments that involve counselling, sound therapy, medication, relaxation therapy or a combination of the four, can help them to eventually habituate, at least to some degree and is an avenue worth pursuing with a trained therapist.

 

What does that imply? That a tinnitus of a measured 10 dB SL would sound as loud to one person as the next without taking into account psychological make-up? Or that the measurement methods are flawed?

 

But there is 80 dB.

 

It means it cannot be reliably measured. Saying one’s tinnitus is 70 dB (without even giving a weighting) is a completely useless frame of reference that is not comparable from one person to another. This is why researchers still currently rely upon questionnaires (which gives tinnitus a score). Hopefully, this is about to change.

It would be much closer if one stated 10 dB SL as there is at least an attempt to reference it in some way, but it still doesn’t account for individual psychoacoustic differences and one’s interpretation of frequencies.

As I said to the OP, I’m not trying to be an asshole even though it could very easily come across that way.

 

I estimated my tinnitus at about 75 dB at the peak, and I habituated over about 18 to 24 mos. It was quite intrusive, and was waking me up from sleep multiple times a night.

This is what helped me:

- vigilant protection from further noise damage (ex: double protection while using vacuum)
- omega3 capsules for over a year
- earplug use at night
- avoidance of further noise events, no concerts, sporting events, parties, etc
- no use of masking devices
- no benzos
- melatonin for insomnia when it was most severe

Hope this info helps others.

 

Hydrops can also be associated with AIED. I was diagnosed with that earlier this year, but seems like I’ve had it for years. My first bout with minor hearing loss occurred in 2015. My second bout with more hearing loss happened December 2019. Several months of testing finally revealed AIED. Thank God my hearing loss is minor but having to habituate to Tinnitus a second time really sucks, now it appears I’ve also developed ETD in my good ear. What a life!

 

Just to clear up any confusion here, as I don’t want to come across as an asshole in this thread: when I say there’s no such thing as X dB tinnitus, I’m referring to it in a comparative context (which is the reason why one would do this). When somebody says that they have 80 dB tinnitus, for example, they believe this gives a fairly accurate description of how loud their tinnitus is for comparative purposes, but it doesn’t. In fact, what can seem like a very definitive indicator of how loud that person experiences tinnitus - so that others can compare - is actually so wide in scale that it’s pointless and is not representative of a value that can be quantified in a meaningful way.

This is why researchers have always been looking for a way to accurately measure tinnitus severity, objectively. One person describing their tinnitus as being 80 dB (as compared to an external sound source) could, in reality, be the same as another person who describes theirs as being 40 dB. This gives a false impression of what one is experiencing compared to another, and that’s why I often reply in threads that use these terms.

The best we can do is describe how loud we hear it on a scale of 1-10, but of course, everyone’s scale is going to be based off a different metric. One persons 9/10 might be another persons 5/10 and vice versa. Answering questions like these, along with a bunch of others, however, is still the most popular way of assessing how loud someone experiences their tinnitus in a clinical setting. The next best thing is the sensation level from a pitch and loudness test. For the vast majority of people, their tinnitus will fall between 5 and 10 dB SL. It’s extremely rare to see people go above 20 dB SL. This is why many get offended when they hear people say that their ENT Dr told them that the loudest is usually around 20 dB. What they are referring to is 20 dB SL, and members here think to themselves, “that’s barely audible! The ENTs haven’t got a clue,” etc, etc, but this just demonstrates my point. It’s like an apples and oranges comparison. People here are using the A-weighted scale to compare to external sound sources that they know to be that loud, and this is where it all goes wrong. 20 dB SL would be extremely loud.

This is why I’m excited to hear about Dr Mehrnaz Shoushtarian’s work, as it is moving towards an objective measurement, and that's exactly what is needed!