How True Is the Idea That Dwelling on Tinnitus Makes It Worse?

Hello there,

My tinnitus comes from either a concussion or ETD. I drive myself nuts trying to understand which in fact is the real cause even though I don't know what difference it would make. It's safe to say that being rather OCD myself, I tend to dwell on tinnitus since its onset. Trying to measure how loud it is, what triggers increases it, etc.

I know there is a theory that thinking on tinnitus too much or negatively somehow encourages its very existence. On the contrary, accepting tinnitus and positive thoughts make the mind push it to the background or maybe go away entirely.

I am torn about whether I believe this theory or if it's just nonsense and tinnitus is physically there at a level based on physiology no matter what we "think" about consciously. Obviously not dwelling on it would be good, but can it really actually do harm and increase just thinking on it?

Any thoughts from you folks on this forum?

 

I don't think it's literally going to make it worse in a long-term, unfixable way.

This is a very complicated question, and what I say probably doesn't apply to everyone, but this is my own personal observation and it's grounded in my understanding of the connection between the sympathetic and parasympathetic nervous systems.

It's less a question of "dwelling" than "being in a distress state". If someone were aware of their tinnitus all the time but it made them happy, we wouldn't say they had a problem with tinnitus, right? (We might say they have a screw loose, but that's another story).

When we're in a distress state, meaning that we have identified something in our perceptions as "unwanted" / "dangerous" / "bad", a bunch of neurochemical things happen, stress hormones are released, and basically we're wired to become more aware of all of our sensory perceptions and enter fight-and-flight mode.

If you get stuck with some chronic ongoing thing that just forces you into a constant state of fear/depression/fear/depression, combined with some learned helplessness, it's real easy to have sort of constant activation / arousal of the parts of the hormone system (HP axis) that control stress signaling.

Over time this does all kinds of bad things, including literally making the amygdala larger. (This is a brain region implicated heavily in the experience of fear / anxiety). Conversely, it's been shown in imagining studies that practices like certain kinds of meditation, can actually reduce the size of the amygdala over time.

If any of this interests you on a theoretical level I can send you some neat papers to read, but they are not very practicable. There's not really anything practicable that can't be learned for free: yoga, meditation, qi gong, etc, all of these things are useful to varying degrees to some people, and some medications are also useful to varying degrees to some people.

I don't think sitting around being miserably fixated on your tinnitus is going to make it literally worse, because I did that for years and I don't think my tinnitus is much different now than it was a decade ago. The bigger risk is just that suffering is an unfortunate and crappy use of time.

 

People are talking about different disorders. One version of tinnitus is the kind that affects every single adult at some point. For sure, this is something that makes sense to never acknowledge.

As the severity goes up, the capacity for habituation goes down. Moderate tinnitus is probably possible to habituate to over a long period of time. Since tinnitus is subjective, I do think it's a good idea to try to habituate just in case you can. Habituation is also smart because most people's tinnitus improves with time so two things are going on at once.

But there reaches a point where I think it's impossible. The people "dwelling" are just holding on for hope until a real treatment arrives. I think everyone can picture, whether they have it themselves or not, very severe tinnitus. This is not something the mind can get used to.

The "negativity" bullshit is just privileged people with mild tinnitus who can't see the difference between cause and effect. I don't know, I guess I just think that if someone wants to invade a support space and talk about how negative it is, it's kind of on them for not logging off.

One can always log themselves off the forums for their own good. However, finding a space where people can unload their suffering is rare. Tinnitus Talk has a model and precedent of limited censorship; that way the people who need that way of feeling less alone have it here.

I can personally say, with severe hyperacusis to the point where I can't leave my house or be around any sound, the "negative" crowd -- who says what everyone is thinking -- makes me feel way less alone. Most support groups are highly censored; everyone has to pretend like everything's okay, even though they spent the last few months/years wanting to commit suicide.

 

I can only speak for myself, of course, but dwelling on my tinnitus, especially when it started and I had no idea how to cope with the noise in my head, most definitely made it worse.

It was like a negative feedback loop, the more I was thinking about it the more more room my tinnitus noises took up and the bleaker my life / my future would appear to me. I was overwhelmed by the situation and for the first six months or so my life seemed to consist of nothing but those two noises. And the more I focused on them the louder they would become and the more upset and depressed I would feel.

Eventually it got better, though "better" really isn't the right word because the tinnitus (at least the initial two noises) hasn't changed, maybe over time it's become part of me. A part I could live without...

I'm not saying that everything is perfect now, I still have days where I feel the only thing that will get me through this day is banging my head against the wall until there actually is a reason for the noises up there to be there. It really very much depends on the way I'm feeling in general; but whether I'm having a good day or a bad day dwelling on my tinnitus, to me, most definitely makes it worse.

 

You have asked a good question and see that you are relatively new to tinnitus. This condition comes in many forms and intensities and no two people will experience it the same, whether it is noise induced or caused by an underlying medical problem within the auditory system. If a person also has hyperacusis which is having an oversensitivity to sound, a condition that often accompanies noise induced tinnitus, it can complicates matters further.

The theory that negative thinking or to be more accurate, dwelling on negativity with the belief your situation will not improve, can make tinnitus worse is true and is no myth. It can hinder or completely halt the habituation process. I am not talking about someone that feels occasionally down or negative about life and wants to express the way tinnitus makes them feel. This is completely different from a person that refuses to focus on anything positive in their life and it can be damaging to them and those they associate with, if they allow themselves to become influenced by the person's beliefs.

For this reason having a positive outlook on life is so important in coming to terms with tinnitus and keeping negativity at bay. I am not saying to always be positive because life is problematic, but everything has to be kept in balance. Acquiring positivity is a process and doesn't happen overnight but a lot can be achieved with time and patience and the willingness to try. In some circumstances professional help may be needed by seeing an Audiologist trained in tinnitus management.

Below, I will list a few articles that I have written on tinnitus and the way it can affect our mental and emotional well-being and advise you to read them. Since you have a tendency for OCD, my advice is to try and guard yourself against reading negative information about tinnitus on websites and associating with negative thinking people in forums. In the early stages of tinnitus it is natural for the brain to focus on the tinnitus and there's not a lot you can do about this. However, this usually improves with time and there are things that you can do to make the habituation process easier. Use low level sound enrichment during the day and at night by placing a sound machine by the bedside for sound enrichment. More is explained in the links below.

The following posts you will find on my started threads: The habituation process, Tinnitus and the negative mindset, Acquiring a positive mindset, From darkness into light, Tinnitus and negative counselling, Will my tinnitus get worse? Tinnitus and mental health, Tinnitus today and the way I see it. Hyperacusis, as I see it.

All the best
Michael

New to Tinnitus, What to Do? | Tinnitus Talk Support Forum
Tinnitus, A Personal View | Tinnitus Talk Support Forum

 

Thanks Michael. Tinnitus, A Personal View is well written and informative.

 

I don't think it makes it worse, but it will make it harder to cope with. Not just with tinnitus, if you dwell on anything too much or for too long you won't get any peace of mind.

 

Thank you for your kind comments @Gman45. Please read the other articles that I have listed. If you have a printer I suggest you print them and read more than once. They are a form of counselling and will help reinforce positive thinking. You will get through this but it's important to incorporate positivity into your life, by doing the things you enjoy, and not associating with people that are too negative about tinnitus, as it can interfere with your progress.

Best of luck.
Michael

 

One more thought on this. You have referenced some folks that say, "I don’t want to be positive about tinnitus, I hate it.". This is me too! It's hard, it's like telling someone with a staph infection to think about it in a good way. That's what's so odd about tinnitus as most conditions it wouldn't matter how/what you think it just is what it is. However, with tinnitus that may not be the case. Hard for me to think about it positively. Regardless, I think you are spot on here. I know that moving on and enjoying life again is the goal. I wish I could fast track my mind to getting there and letting go of worry over tinnitus.

 

Leila - Negative feedback loop is right. That's where I'm at right now at 2 months in with this. I want a vacation from my own head. I will try and stop dwelling, as I know it's not helping.

 

I know 2 months is not a long time, but it's the future of forever with tinnitus that of course is daunting and hard to cope with. I do think intensity of the sound makes a difference too. I have relatives with mild tinnitus that say it's no big deal. Of course, they go on to say that they can't even hear it until it's very quiet when they go to bed. If that was the case for me, I don't think it would be a big deal either.

 

In my experience dwelling on it absolutely makes it worse. The very idea of habituation is teaching your mind/neurological system to ignore the sound as just a meaningless background noise. This is largely done on the subconscious level, but I have certainly had the experience of consciously focusing on the sound and suddenly being able to notice and feel all the really painful noises that are embedded in my tinnitus.

 

Interesting, I have certainly found myself more fearful of all kinds of life stuff that before the onset of tinnitus never bothered me. Conversely as I get farther away from the trauma part of it I am finding that this fearful reaction is reducing as well.

 

@Michael Leigh,

I always appreciate your feedback. I was just wondering what insight you have into changing tones etc.

A little background on me:

I originally got tinnitus bilaterally in 2015 following an AC/DC concert. It cost me great distress as you can imagine. But with the help of sound therapy I managed to cope and within two years it was completely gone. And I mean completely gone.

Fast forward three years, late last March early April I started to notice an echo in my left ear. Hearing test revealed minor loss at one of the lower tones. ENT thinks it was a virus since it only affected one of my ears. Again lots of anxiety, not eating taking anxiety meds. A month later I developed bilateral tinnitus very high-pitched that is variable. Sometimes it’s louder and I can hear it over other things and sometimes it’s barely there at all. I have managed to adjust to it all. I use sound therapy for the high-pitched bilateral tinnitus and it works very well. And a lot of times I don’t even need it. I was also got used to the echo in my left ear. Didn’t bother me to hear it now and then when there was no other ambient noise. No longer caused me a lot of stress. And generally speaking, when I could hear it I would ignore it. However I just want to note that I am never in a completely quiet room. As that noise echo will permeate my head like nobody’s business.

This morning I noticed that I had a pure tone ring in my left ear. I have occasionally, over the last 10 months had isolated periods when I could hear this ring. Sounds kind of like when your TV goes off-line. And at times when hearing the echo (my normal tinnitus sound), if I blocked my ear I could hear this faint faint tone in the background. But most times I blocked my ear and I just heard the echo that sounds like a seashell. So essentially, that pure tone ring would seem to only rarely come and go and never stuck around very long. Maybe an hour or so and it was also not very loud. Now things seem to have changed. This is much louder although I can still mask it and it doesn’t seem to be abating and it has been about six hours.

So my question is do you have any experience with this? I have read of people saying that they have frequently changing noises in their ears. But most experiences I’ve read about have been people who have a consistent noise that hasn’t really changed much. I thought I was in that bucket. I thought I was doing really well. And now I’m in a tailspin again. I feel like every night I will go to bed and wonder if I am going to wake up and it’s going to be worse or changed and my life is going to be in upheaval.

I’m so upset because I worked so hard to be doing well and I just feel like this is such a setback.

Thanks in advance,
Danielle

 

It is quite normal to have an adverse reaction towards tinnitus especially in the early stages. I assure you things will get easier it with time. Print my articles as I've suggested and keep them in a folder and refer them periodically. As time passes your brain will learn not to focus on the tinnitus as much. You'll look back, smile and say what was all the fuss about. Tinnitus is a very common condition and many people are able to live their life quite comfortably with it. Just take one day at a time. I advise you not to use headphones, earbuds or headsets even at low volumes.

Take care
Michael

 

HI Danielle.

Thank you for your kind comments.

Tinnitus can be complex and no two people experience it the same although they share similarities. My tinnitus was noise induced like yours. When I got it 25 years ago, I experienced fluctuations, variable high pitched tones and the echo sensations you describe. I correspond with people affected by noise induced tinnitus. They also experience fluctuations and high pitched multiple tones but not many mention the echo sensations.

My tinnitus remains fairly stable and doesn't deviate too much. It is variable with large fluctuations in intensity resulting in no two days being the same but I have habituated to this. I no longer experience blocked ears or echo.

Noise induced tinnitus will usually stay the same unless a person subjects their hearing to overly loud sounds, which can result in a spike, even when earplugs are worn. If a person returns to using headphones, earbuds or headsets, this can make the tinnitus worse. If you haven't been using any of these devices and haven't regularly been around loud sounds then, the echo that you describe could be related to ETD (Eustachian tube dysfunction) People with this condition are known to experience tinnitus and sounds that echo.

It is good that you are using sound enrichment but needs to be used correctly. Try not to mask or completely cover up the tinnitus so that it can't be heard. This is not the correct way to use sound enrichment as your brain will not learn to fully habituate to the tinnitus. Set the sound enrichment slightly below the tinnitus. It should be playing in the background without drawing attention to itself, particularly at night. Try not to sleep in a quiet room even if your tinnitus is low. Set your sound machine at low level so it's not drawing attention to itself.

Your ENT doctor may be correct and your symptoms are related to a virus. If things don't setting down, I advise returning to see the doctor and have your hearing checked again. I also recommend your Eustachian tubes be checked. This procedure is usually carried out during a hearing test so this may have already been done.

Hope things improve for you soon.

Michael

 

Michael,

After all this, I think my days of using headphones and earbuds are over. I'd say historically I used those about a normal amount. Wearing them on airplanes or exercising. The airplane thing was probably not the brightest since you have to turn it up enough to hear over the engine roar. Won't do that again.

My tinnitus seems to be related to either a concussion or ETD, but I've probably not been the kindest to my ears in my past with music. Most of that loud music in the past is many years ago, but I think noise damage can be cumulative. I have a hearing test soon with my ENT. I'm pretty sure it's concussion or ETD because I've heard pure silence for all my life until 1 week after a mild concussion when loud, intrusive tinnitus turned on. My ENT said ETD though, and ears do have a plugged sensation since all this.

Will refer to your writings. Good stuff as you speak from experience.

Gman45

 

Best of luck at ENT Gman. If you reduced the use of headphones or stopped using them, it would be better.

You will be fine. Just take things slowly.

Michael

 

@Michael Leigh, thank you for your thoughtful response.

I am reasonably sure that my first tour of tinnitus started as noise exposure. That sounded a lot like a light saber going off in my head. With a tad of ringing. At that time, my hearing tested completely normal. And it did legitimately go away after two years. What I’m most perplexed about is what could cause this instability now. It’s been about a year since I have my new presentation of tinnitus and I can tell you that I never use AirPods, earbuds or head phones. I have not had any loud noise exposures. At all. I’m actually super careful. I even wear my custom made musician earplugs in the movie theater.

The only thing that’s changed for me is when I first got tinnitus in my left ear, I had a lot of pressure in my ear. And my ENT said your hearing loss is so minor that you should not be experiencing that and we think it’s your jaw, as in TMJ. This was based on information that aural fullness can be caused by hearing loss. That pain and pressure eventually just went away. But I had it pretty bad for a few months -to the point that they were times I just wanted to cry it hurt so bad. I have a little pressure now but not bad. By the way, last year when this came on there was absolutely nothing wrong with my ears, no ear infection, no fluid, no nothing. I talked to my ENT about eustachian tube dysfunction. He said it’s possible, but said when we examine you we can’t see your eustachian tubes so we don’t really know if that’s having any impact.

I just can’t believe that I have to go through this all over again. Like how many times is this going to change and I have to try to habituate? My worst fear was that it would come back after it went away after the first time. And it did. Then I lived with a fear of it getting worse. It certainly didn’t get better. But I got used to it. And now I’m here. Most people I know have said that theirs just stayed the same. Wish I was one of them.

 

@linearb - The papers you refer to do sound interesting. Is it simply a link?

 

I think if you're going to habituate, ultimately it will happen in the long run without you trying to make it happen one way or the other - your brain may develop that groove to accommodate the noise. Conversely, if you're not going to habituate, it's always going to be somewhat annoying, and you "dwell". Personally, I don't think dwelling makes it worse - it's actually that it is worse for some and so they can be said to "dwell" while others pass by.

To put it in other terms, I really doubt you can make the sound louder, and recruit new cells to lose lateral inhibition, by focusing on the noise in some sort of death spiral, whereby your focus makes it louder and it being louder draws more of your focus.

Succinctly then, dwelling does nothing either way in objective terms.

 

The information that you have given in your post is all that I have to go by @Forever hopeful so this is what I think.

You have said it's about a year ago your tinnitus changed. Prior to this you habituated quite well. As I have previously said, noise induced tinnitus usually remains stable once a person habituates. The main cause for it increasing is usually related to sound. Either it is headphone, earbud or headset use or exposure to other types of loud sounds that you may not be aware of.

Since you don't use headphones etc they can be ruled out as causing the increase in your tinnitus. However, you mentioned wearing custom made musician earplugs when attending the movie theatre. If you regularly went there or attended nightclubs, concerts prior to COVID-19 lockdown, this could be the reason for the increase in the tinnitus.

Many people that have noise induced tinnitus, believe once they are wearing earplugs they can attend the movie theatre, clubs, concerts and other places of entertainment and they will be safe. Unfortunately this is not the case. As I have said in many of my posts on noise induced tinnitus. If external sound is loud enough, it will pass through the head/skull and transfer to the inner ear by bone conduction and irritate the cochlea. The person may, or may not develop a spike. The tinnitus could increase ever so slightly but they are not aware because their brain has learnt to habituate. If the person continues going to venues where loud sounds are present, unaware they are being exposed to loud sounds because of noise reducing earplugs, their auditory system is being adversely affected.

Many people in this forum have mentioned attending the movie theatre, clubs, concerts and noticed their tinnitus increased even though they have worn custom made earplugs. They are not one hundred percent safe, because if external sound is loud enough, it can pass through the head and transfer to the inner ear by bone conduction.

Michael

 

There has been so much research done on this, both from the general perspective of understanding how mindfulness/meditation impact brain structure, as well as looking at it from the other end and trying to understand how tinnitus impacts and is impacted by brain structure, that it's pretty daunting to try to summarize. These papers, and then the networks of papers which cite or are cited by them, are all quite relevant.

1. The role of the amygdala in human fear: automatic detection of threat
2. Amygdala Activity, Fear, and Anxiety: Modulation by Stress
3. Tinnitus and hyperacusis involve hyperactivity and enhanced connectivity in auditory-limbic-arousal-cerebellar network
4. Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli
5. Does Chronic Tinnitus Alter the Emotional Response Function of the Amygdala?: A Sound-Evoked fMRI Study

As far as a practical manual for how to put this to work from a more or less science based perspective, the book Full Catastrophe Living by John Kabat Zinn is very approachable.