Medical (Neurological) Explanation of Habituation

Could someone explain to me what medically happens in your brain when you habituate to tinnitus?
Not just " you get used to the sound, it doesn't bother you anymore, you won't hear it as much anymore"
More in terms like "this part of your brain does that, which leads to another reaction from another part which eventually leads to the lack of perception of tinnitus"

 

I think it's all pretty theoretical at this point; we do have EEG, fMRI and C/T studies of tinnitus patients which show among other things, decreased auditory alpha wave activity, decreased gray matter in the ventral cortex (and, interestingly, decreased gray matter in the right anterior insula in people who are bothered by their T, but not in people who have T and are not bothered by it)... but tying that all up into one neat package, and then doing it over and over again to the same group of people as some of them habituate, is just not something that's been done as far as I know.

There's reason to think that decreased vigilance/attention to tinnitus, actually results in decreased electrical activity in the auditory system. This is in line with general imaging studies of people doing various attention tasks, and is one good reason to think that "not paying much attention to T" can literally decrease the signal strength / volume, at least for some people.

Out of curiousity, why do you ask?

 

I'm a very practical kind of person. It helps me to believe in habituation and get me through the hard times, if I know exactly how it works. I like hard evidence

 

I wanted to ask that same question!
I too, was wondering exactly what habituation actually was.
That is helpful to know that if you don't pay much attention to it, the volume can decrease.

 

If you can figure out how to consciously not pay attention to something, you will have solved the ancient riddle, "whatever you do, don't think of an elephant"

 

Lisa
I'm the same way; it really helps (me) when I know, to some order of precision, what is going on. I don't think I can give you the 'neuro-scientific' answer you may be looking for but I can share the basics that I have learned (as I understand them). Please forgive me if you already know this.

Essentially it comes down to your brain's 'emotional tagging' (of anything, but in this case T). Your auditory system is integrated with various parts of your brain but for our discussion it is integrated with your hypothalamus (memory), your limbic system (emotional seed) and your central nervous system (CNS). A simple way to highlight how it works is via what I call the 'gunshot' analysis. For instance, consider yourself at a shooting range and you hear a loud gun go off (maybe you weren't expecting it); naturally you jump a little bit but you immediately realize you are at a gun range and all is perfectly normal. What just happened? Auditory data passed through your limbic system and was 'emotionally tagged' (danger data?? your auditory system's primary job is to keep you out of danger, so it is very quick to set off the danger flags/tags); since the sound was so loud (and unexpected) your CNS reacted (ready for battle!) but then your hypothalamus (memory) calmed the whole thing down because you remembered where you were (and later you may remember the incident and laugh a little bit). So, now change the scenario; you are at the Mall of America and you hear a gunshot (holy freaking cow I'm gonna die!!!). Follow the same pathology and you end up with a ginormous emotional tag, a CNS on freak out for two days, and a memory you will keep for a life time and quite possibly relive (emotionally) every time you tell it to your great-great-great grand kids.

Along comes T; a sound that is austere at best and scary at worst (danger??). Remember, your auditory system alerts you to danger and causes the limbic system to tag-the-crap out of this 'dangerous' sound. It reminds me of the robot in the old TV show Lost in Space; always exclaiming 'danger Will Robinson!'. That's your auditory system.

Focus is key. Heavy emotional tagging is a large part of what causes us to focus (fixate??) on something/anything. We are all well aware the negative spiral that is T (T causes anxiety, anxiety causes CNS to go on alert, heightened CNS = anxiety, anxiety causes T to go up, we focus on T even more, round and round it goes).

Realizing T is not a danger and stopping the excessive emotional reaction actually does go a long ways to managing T; I will attest to that personally. But it's not easy; it took me a long time. No, it doesn't get rid of T; but it certainly calms it down and, more importantly, calms you down. Calm is calm (not anxious)

I believe there is a time during the onset-days of T wherein the brain is simply placed into high anxiety mode and there is little you can do about it; at least that is how mine played out (it stunk beyond all reason!! I had 2x nervous break downs)

I also realize habituation is as individual as T is unique to each individual; therefore, habituation can happen via different paths and on different timelines. For some it simply doesn't happen but for most (95% ??) it does.

This is my understanding of the core mechanisms/components of the brain and T.

Mark

 

@Mark McDill, although I like your explanation and analogy with the shooting range I have to say this, T is a never ceasing machine gun. And for some it's war. The gunshots become bomb explotions. Even though, you keep telling yourself, 'I'm not in a shopping mall.' and you don't react emotionally to all the excruciating noise (and painful headache) it won't give you any peace 'cause you perceive it unasked non-stop when being conscious. Keep in mind, the auditory system is also there for entertainment, which triggers your emotional reaction (limbic system). People like to dance and sing. So listening to music can change your mood profoundly. Now imagine there's a very very bad band playing in total discord. Of course, in that case you could simply walk away or change the channel, right? Not really in the case of T. Still, being forced to listen to this shi**y band will very likely change your mood; especially if they never stop.

 

I can actually help here, @Lisa123. One of my clients is one of the world's top psychiatric facilities and I was privileged to participate in one of their Continuing Medical Education courses recently.

Habituation is largely a neuropsychological phenomenon. Changes in behavior, when consistently repeated over a period of time, will create new pathways of efficiency for neural networks in the brain to communicate more rapidly. This de-emphasizes other neural processes in the same affected regions that aren't as efficient, and over time, these pathways become less active. In short: the brain becomes less active (or really, less "re-active") to the stimulus of Tinnitus. This gradual process happens inevitably for everyone - though some people habituate more quickly than others because, for unknown reasons, these neural pathways form more quickly in some people than in other people. Cognitive Behavioral Therapy, or CBT, is said to accelerate the formation of these pathways because you are in effect de-emphasizing the destructive behavior (i.e., obsessing or focusing on the Tinnitus) and you are emphasizing the constructive behavior (i.e., ignoring the Tinnitus).

People who are habituated are not cured of their Tinnitus. They simply do not react to it as much as people who aren't habituated. Any person who has been habituated to Tinnitus, or to any stimulus, can re-engage with that stimulus if they focus. The classic example in habituation neuropsychology is the "sitting in a chair" example. Because we have been sitting in chairs for most of our lives, we generally don't notice the pressure that the seat has against our backsides, the compression our legs feel, and the posture or constraining position that sitting produces. (In fact, sitting has recently been determined to be the cause of numerous cardiovascular ailments, amazingly enough.) However, if you - while you are sitting - start to focus on how your backside feels, your legs feel, and you notice the stimulus of being compressed against the chair, you will very quickly realize that you are being constantly stimulated by the chair/seat. You just don't care because you've been habituated to it; and it is second nature, so you tune it out because the more efficient pathways are to just "sit" and move on.

 

NiNyu
Totally agree; it's a loose analogy, but it was only intended to convey the basic auditory pathology and perhaps highlight the difference between a regular sound and one that is tagged as dangerous.

There is no doubt that continual, raging T (with H) is far different than a singular event (no matter how terrifying); however, the underlying truths are the same -- eventually your brain will stop tagging it as danger (as you realize it is not a danger) and you will stop reacting to it.

That being said, one of the biggest challenges (speaking personally) is not only to stop reacting to the sound but to stop reacting to the 'idea' of T. I'll be perfectly honest, I grew accustomed to the sound (of T) far earlier than I grew 'comfortable' with the idea that I had T (bugged me no end, I hate the idea of T and that something is happening to me that I cannot control). I'm thinking the limbic system is involved on this level as well. I'm now settled down (to a workable degree) with the idea that I have T -- but I still don't like it and I reserve the right to hold it in disdain. The key is, it no longer holds much sway over me (I'm the boss now); but that took a while.

My apologies if all this sounds 'blah blah'; I don't mean to come across condescending or menacing and, again, I apologize if I make you feel that way. I see you've had T since Dec 2014; that is a very recent onset (in the timeline that is T and habituation). I had 2x nervous break downs within the first six weeks; it was a living hell that I can't compare to any other hardship I've endured.

I also recall realizing (after some months) that T had thrown everything it had at me (at a time when I had the least coping skills, essentially zero knowledge about T, and had it thrown my life into a wasteland -- didn't want to live and couldn't imagine living this way) and yet, I was still there. Therefore, from a factual standpoint I had to admit that it didn't defeat me (and likely couldn't); it was from that point on it became easier to choose to manage and to eventually overcome; but it was clearly, and always, a choice for me to make. Again, it took a long time (months) for me to get to that realization; so cut yourself some slack and try try try to be patient.

Mark

 

@Kaelon, 'sitting in a chair' is a nice psychological analogy but there's one problem with it. We do not sit 24/7 in a chair. Moreover, when we sit in a chair we usually do other stuff than just sitting in a chair. And this is why psychology does not work on T. Now my butt hurts from all the sitting here.

Nevertheless, I agree to some extent, that the brain can become less reactive to a certain constant stimulus as long as this stimulus is not fluctuating. Best example is the 'locust effect'. That's why ha-bitch-uate is almost as good as impossible for people with extreme intrusive T.

 

Precisely, that IS exactly how I feel. I do disdain being controlled by something or someone!!! 'It' holding control over me. 'It' torturing me. And there's nothing I can do about it. I do not want to live and can't imagine living this way. I am merely here cause -- I haven't found the right way to extinguish this monster. There must be a way.

No, no you do not sound blah blah. You sound reasonable, and strong. Thank you. ~hug

 

Thank you Mark and Kaelon

 

@Mark McDill Thank you for your amazingly descriptive post above. How long did it take for you to get to the point where you have settled down to a workable degree, and what treatments and/or techniques did you use?

 

svintegrity
I went through stages of settling down; overall it took a little over a year to get to that 'workable' point -- and by workable, I mean that T didn't push me around so much. T was still a big deal in my life (and to some degree and in some dimension it will always be a big deal to me) but it no longer bosses me around and most days I just forget it's even there and when I do bring it into my conscience thought it is more from a curious 'let's study this thing; how's it work?' point of view.

In my dark days of T (2 x nervous break downs, et al) I found an audiologist that was a true God send (Ed Granger); he 'talked me of the ledge' (weekly, for the better part of a year) but the big thing he did for me was fit me with hearing aids equipped with white noise generators. The white noise is programmable for my specific T and was the only thing I could find that would actually mask my T (at first, even they weren't able to mask but within a few weeks the maskers started 'winning'). It was the masking that made a huge difference; a way to get my brain off the torture train (settled down) and break the vicious cycle involved with T. Unfortunately, the maskers are legally bound to no more than 60 db continuous white noise and at the beginning my T was much louder than that (it was stupid loud!) and so my anxiety and depression soared for a few weeks (thinking nothing would work). Eventually I calmed down and the maskers started taking hold. It's kind of a combo-platter of dynamics (masking and natural habituation working together, masking helping the natural habituation process). The white noise generators are awesome, I still use them to this day (although not nearly as much).

Mark

 

Hi Mark, Thanks for your reply. I have had some pretty dark days myself over the past year. Met with five different ENTs and three different audiologists. One audiologist who is a T and H specialist was particularly bad. I was truly losing all hope of bring able to function. Habituation to a car slat. Going off in my head just wasn't possible.

Everything that was supposed to help with the noise only made it worse. I tried masking hearing aids, acupuncture, chiropractics, craniosacral therapy, intra oral massage, TMD treatments, ultrasound followed by massage, TENS, and Neuromonics. Everything sent my noise screaming into the ozone. The Neuromonics especially gave me high-pitched screeching in both ears, and severe Hyperacusis.

Now, don't get me wrong, I am used to pain, and have a high pain threshold. I trained at the Olympic Training Center in cycling, was a marathon runner, high altitude mountaineer with a few summits in the Himalayas, and did 50k ski marathons. But this T and H is bringing me to my knees! After a year of suffering and searching, I finally found a neuro-otologist, who found the right neuro-radiologist, who found the reason for my sudden onset intractable, debilitating tinnitus: microvascular compression syndrome.

Apparently, it is rare to find this condition in a case of T, and even rarer to be a candidate for the surgery. I guess I did always like to be different. I am scheduled for brain surgery in two days, with a team of two of renowned neurosurgeons. I never thought I'd be looking forward to having a hole drilled in my skull, exposing my brain to decompress my auditory and vestibular nerves. No wonder I wasn't habituating, as I have no significant hearing loss, and excruciatingly loud T, because I have an active input in my inner ear.

I may have some mopping up to do with residual noise, from possible nerve damage, after a year of my cochleovestibular nerve being very angry. Your message gives me hope for that. Best, SV

 

Typo above should have read losing all hope of being able to function with a car alarm going off in my head indefinitely. Sorry about that, my iPad likes to autocorrect. It thinks it knows better!

 

SV
Good night almighty, you have had a real go of it! Yeah, I would guess habituating to that would be a far different matter than most (to say the least). I couldn't imagine having tried all those techniques and still no results; thank God you found some neuro-surgeons that have diagnosed and will fix (that's amazing!).

That level of T/H would have taken me to my knees within weeks (not a year); you are one tough cookie!

I know what you mean about iPad auto-correct (slat / alarm); someone needs to put together a comedy-line of all the unintended consequences from Apple auto-correct . It gets everyone at one time or another -- funny.

Please consider sharing your surgery outcome when done; this is fascinating and inspiring! I can't help but think of others on this site that have similar struggles (yet, no answers or hope).

Thanx so much SV!!

Mark

 

@Mark McDill Thanks for your inspiring reply. I also didn't mention that I am no stranger to suffering. A pack of five dogs dragged me off my bicycle during a training ride and chewed up my leg. Emergency surgery, and a year of hospitalizations followed from complications. My first husbsnd died in a mountaineering accident, I have been through two cancer surgeries, and radiation sickness like you wouldn't believe. I lost my mom who was my best friend in the whole world. But this intractable, debilitating T/H is bringing me to my knees! Without the undying support of my husband, I would not be making it through this journey with T/H, and it takes not giving up. I will share results when I am able, I guess I will be in ICU for awhile. Yes, a comedy line of all unintended Apple autocorrect consequences is in order. My favorite is when it changes Namaste to lambaste--two totally different meanings. I so appreciate your upbeat attitude. Namaste, SV

 

@svintegrity you need to write a book titled 'Human Suffering; A Tale of Conquering'; I'll buy the first copy.

ICU = not fun; I hope the surgery works out -- I'll pray that it does. I hope you won't be in ICU too long (yikes). You sound very resilient; I think it will go well (my hope).

Namaste/lambaste autocorrect; so funny. Our current implementation of artificial intelligence is going to take us to new lows (of IQ) . I can't miss the irony of all our technical brilliance in society causing such silly outcomes (hilarious). I'm a software developer and I know (first hand) that if you really want to mess things up write functional malware; I refer to this as software 'duh'velopment -- of which I'm guilty .

I want to hear about your surgery (outcome, et al); thanx.

Mark

 

@Mark McDill Hey, I was pondering a good title for my book. I think you nailed it! On a serious note, I titled my publication about my first husband's death in a mountaineering accident: "In This High Place: The Long Climb Back." It has helped many young widows over the years.

I shouldn't be in ICU too long, just a precaution. The two neurosurgeons are very optimistic, because of the many patients they see, most are not even a candidate for this surgery.

Love your use of the term software 'duh' velopment. Of course, Stephen Hawking warned years ago to be cautious of artificial intelligence. We as a species are not gaining intelligence, and are limited by slow biological evolution, but the intelligence we are creating is gaining in leaps and bounds. Like you said, "to all new lows (of IQ)."

I appreciate your good wishes and good cheer. Will be in touch. Namaste, SV

 

Wow! That sounds interesting. Can you tell us more about it?

Anyhow, I'll keep my fingers crossed that the op is going to be successful for you. You merit it. Best wishes. ~hug

 

@NiNyu Thanks for your best wishes! A very specialized MRI was ordered by a neuro-radiologist. The results show an artery compressing my auditory nerve and displacing my vestibular nerve probably causing the loud, non-stop, high-pitched pulsing in my right ear. It sounds like a car alarm going off in my head 24/7, but I am sure I have said this many times. Sorry if I am being repetitive. With this nonstop, loud noise, I am not always thinking clearly. The noise is literally unmaskable. Thanks for keeping your fingers crossed. My heart goes out to you too! ~hug

 

Hi @NiNyu -

I don't disagree with you, and I also make it a point to say that "habituation" is not a cure, and that people who have "habituated" to Tinnitus still actually hear it. They just don't care / it does't bother them. That said, habituation is absolutely possible for even people with extreme, intrusive Tinnitus - but they may require assistance. Cognitive Behavioral Therapy, or CBT, is the best bet where there is no other way to gain relief. @Dr. Nagler, I believe, is a proponent of Tinnitus Retaining Therapy, or TRT, which is a form of CBT; he has written elsewhere here that the sound of his Tinnitus is extremely loud and can be heard over waterfalls, for example, but he's learned to live a full and active life, and not let Tinnitus run his existence. His story is an inspiration to everyone.

You mention that the brain can only become less reactive to "constant stimulus," and while it is certainly true that habituation is easier when stimulus is present all of the time, even Tinnitus that fluctuates or pulsates can be habituated over time. According to statistics, most people are able to habituate (or at least, begin the habituating process) within 18 months of a chronic onset of a new, unwelcome stimulus -- and this is if they don't try to do anything, positive or negative, to help or hurt the habituation process.

I hope you will find some peace soon!

 

@svintegrity, you're welcome. ~hug that sounds promising! If they've managed to find the cause there can be a reasonable treatment, thus a cure! Gosh, I'm pretty excited for you.

How was the MRI? I heard it's pretty loud. One ENT suggested me to make an MRI too. But I had to decline for now due to my H. Keep in mind tho, I've lost most high-freq. I can only hear up to ~2400hz (left ear).

Thank you. ~hug

 

@NiNyu Yes, the MRI was excruciating with my H. I think I scared some people in the waiting room when I came out telling my husband how awful and excruciatingly loud it was. The people in the waiting room turned white as a ghost, before my husband interjected that I had a special scan, and a debilitating condition related to noise.

I had 2 MRIs, a MRA, and a CT scan before this last MRI. It was the CT scan that lead the neuro-radiologist to order the recent specialized MRI (imaging wasn't sure how to schedule it, because it was a rare scan). The CT scan was quick and silent, so maybe your ENT could get some information from that. I recommend a neuro-otologist, instead of a regular ENT. I had been to five different ENTs and they all glazed over when I mentioned the T-word. Tinnitus? Just learn to live with it! It was so depressing, because nobody could live with this.

I had previously been to a neuro-otologist last year who said that nothing could be done. I decided recently to get a second opinion from another neuro-otologist at a Neuroscience Center. It was there where the neuro-radiologist found the offending artery pressing on my auditory nerve. No wonder it is so loud! And it pulses with my heart-rate. I tried TRT early on, but the audiologist said, she couldn't tell me that it was just a noise and that nothing was wrong, because something might actually be wrong. I kept searching and searching, and trying treatment after treatment for a year. Everything I tried made it worse. Neuromonics gave me high screeching sounds in both ears, and made my H go from moderate to severe.

Keep trying to find something that will help you NiNyu. Don't give up, there is something out there that will work for you! I am counting on you to find that button. ~BIG hug

 

Good ole' Monday morning research; found a little info about microvascular compression syndrome (neat stuff)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793889/
http://american-hearing.org/disorders/microvascular-compression-syndrome/

Very interesting...

Mark

 

@Mark McDill I love your Monday morning research. I just had surgery for MVC by two teams of neurosurgeons. There were 8 brain surgeons in the operating theatre. One surgeon from Canada exclaimed that he "never thought he'd see one of these!" Mine was a classic case in this regard, with the artery compressing on the cochlear nerve, and displacing the vestibular nerve. All of the surgeons were ecstatic about how well the surgery went. Directly after a 3 hour surgery, they then took me for a post/op CT scan before I spent 2 days in ICU. And then I spent 5 days in the hospital in the Neurosciences wing. My T decreased by half, which is not nearly as much as I had hoped, but I'll take it! Also the lead surgeon told me that even though they were careful, they had really stretch those four nerves, so it could take about three months to heal. I now am doing vestibular rehabilitation therapy. Because of the over-stretching of the vestibulocochlear nerve, which caused killer vertigo. I would only recommend this surgery to people presenting as classic cases for MVD, and I know that none of the neurosurgeons on the team I had would attempt this surgery without certainty of this condition for their patients. I am looking forward to more of your Monday morning research. You always find fascinating topics and resources.

 

Hope all goes well, good luck! If only I were as strong as you are!

 

SV
Great news! It sounds like it went well; I'm with you, I would take half-volume any day of the week.

The vertigo doesn't sound fun; but it also sounds temporary (whew!). I hope the VRT goes well; what did they say about the nerves healing?

So glad to hear from you; thanx for keeping me posted.

Mark

 

Is this not the problem for all of us? I am guessing that almost all, if not all of us are/were pretty much in control most situations in our lives. Then along comes T and we lose total control and it drives us nuts until we truly realize this is something totally beyond our mastery. What I am trying not to do now is control my T. If there is one thing I have learned coming to this forum is that it's a lost cause trying to rid myself of this affliction. It can't be done, at least in the present time, and this is very humbling for me as I have always been either able to fix or have someone else fix things for me. I find myself somewhere in the middle of my quest for habituation so I just plug along one step at a time. I have convinced myself that I cannot control the T. I am determined not to have it control me. This all was a first big step for me. Maybe it can be for you and others.

FWIW.... I can hold my wife's blow dryer (hair) on high about 6 inches from my ear and can still hear the T.

Crap! I feel like I just stood up at an AA meeting.

dennis