Response to Cullen's Excellent Question on Masking and Habituation ...

@cullenbohannon asked in another thread:

"Dr.Nagler, I was thinking about what you said about masking. Do you think some people get by with T with masking and don't necessarily habituate and if this is the case, if these people have a spike or some situation where they focus more on T, would they have a harder time habitating at the newer louder t. I was wondering if that's not what happens to people on here, where they get to a point where they just don't hear most of the time, but they aren't necessarily habituated. Hope that makes sense."

..............

I don't know, Cullen, and I don't care.

Well, that's not right. I do care; I care very much. What I want is for you not to care.

Cullen, I believe you may be over-thinking this a bit. I recall that I sure did when I was in your shoes.

If a person can achieve total masking, and if he or she is satisfied with the immediate relief thereby achieved, then I'm all for it. Decide that the achievement of immediate relief is the goal, and consider the facilitation of habituation to be a bonus rather than an expectation.

If the goal is the facilitation of habituation, then the principle is: You cannot habituate what you cannot detect. So the idea would be to avoid purposeful total masking.

Is it at all possible for people who totally mask their tinnitus to ever habituate? Yes - because you cannot totally mask 100% of the time.

Most importantly, when you have largely habituated your tinnitus - whatever your strategy for getting there might be - spikes are irrelevant. When they occur, if they occur, they might distract you ... but they will cause you little, if any, distress. Why? How can that be? It's because distress is a reaction, and that's what habituation is all about: Reaction.

What would I myself do today - right now - if I wanted the fastest possible path to the facilitation of habituation? I'd do exactly what I did twenty years ago: I'd do TRT. Am I biased in that regard? Sure, a little. But having spoken with tinnitus clinicians the world over, and having studied the literature backwards and forwards, I am also convinced.

Hope this helps more than confuses.

Dr. Stephen Nagler