The Habituation Process

The habituation process.

Habituation is frequently talked about in tinnitus forums and probably comes in at second place to the popular question: when will a cure be found? It seems some people have become quite taken with this word and believe it is the most important thing to strive for when dealing with this condition. Everyone wants to habituate as soon as possible and carry on living their life doing everything that they want to and putting tinnitus firmly behind them.

I can honestly say that I see nothing wrong with that, but wanting something in the speed that we would like it isn’t always achievable, especially with something like tinnitus. A few people that have had tinnitus for a while, have contacted me to discuss just that. They have concerns about the length of time it’s taking to habituate. Similarly, I have heard from those new to this condition that want the habitation process to start as quickly as possible. Both groups tell me they are doing all the right things but it seems patience is giving way to despondency and despair and some are starting to believe habituation might never happen for them.

It is of little comfort to these people when they hear family and friends say, tinnitus is just a minor irritant and something that can easily be ignored. Occasionally, it might be intrusive but this is never more than temporary and they are still able to carry on with their life unperturbed. I often sense the frustration a person is under when they are relaying this to me. Whether I’m talking to them on the telephone, private messenger or answering an email. It is then that I’m often asked: why is it that the habituation process doesn’t seem to be happening for them?

Answering such a question isn’t easy because there is no single answer that I can provide but I will say this. Tinnitus is a common condition that comes in many forms and intensities and no two people experience it the same. It can be very troublesome especially in the early stages of onset, but gradually this gives way and the condition settles down and in time many manage to cope with it when it’s mild or moderate. Sometimes this may involve treatment via a hearing therapist or a person achieves this naturally without being referred to a clinic.

It should be noted that tinnitus can be a complex condition, depending on how loud and intrusive it is for the individual? So what I’ve just outlined won’t apply to everyone. There are other factors that also come into play. A person’s make-up or rather their outlook on life. Whether they are positive or negative thinking can help or delay the habitation process. In addition to this, stress and anxiety are often associated with tinnitus and a person might be taking medication such as an antidepressant to help cope with it. There are a myriad of scenarios that I could relay to you on how tinnitus can affect someone’s quality of life, their well-being and the habituation process. For now I will say this:

When a person habituates to tinnitus it means they are able cope with it but this doesn’t mean they will never hear it. Although some people habituate to a level where the tinnitus is rarely heard or stays at a very low level. Whether the tinnitus is silent for periods of time or remains low, mild, moderate or is occasionally intrusive, it doesn’t really matter, because it all means the same thing. When habituation is reached a person will know, because whatever the level it will not bother you. However, like everything there are exceptions and tinnitus is no different. I believe there are some limitations to habituation. As I have previously said the condition comes in many forms and intensities. Some people have variable tinnitus that can fluctuate from silent, mild, moderate and severe. When it is loud and intrusive (severe) and this level is sustained for long periods it can become very debilitating and a person might have to take medication to cope with it, which is usually supplied by their doctor. This level of sustained intrusiveness shouldn’t be confused with a tinnitus spike, which usually returns to baseline within a short period of time.

I want to say that I believe habituation is achievable for most people with time. In some instances a person might need the professional help of a Hearing Therapist or Audiologist, as there are a variety of treatment options available to help one in the habituation process. One should also try to be realistic. There are some people that will accept nothing less than a complete cure from their tinnitus and this is unfortunate, because they could waste a lot of time being miserable.

I have corresponded with people that have said, their tinnitus is very low and is only heard occasionally or in a quiet room, at night for instance. Yet these people are not satisfied because they want a complete cure and will deliberately seek out quiet surroundings to monitor their tinnitus, checking to see if it has increased or not. It’s as if they have become obsessed with this condition and to the point where is starts to affect their relationship with those that are close to them, and I don’t think this is healthy.

In summing up I want to say one last thing. Those that are having treatment with a Hearing Therapist, Audiologist, or finding that their tinnitus is becoming less intrusive and they are in the habituation process. Try not to read negative posts or associate with negative thinking people who are not in the same place that you are, as their beliefs can prevent your advancement, if you are not careful.

I wish you well
Michael

PS: further reading on habituation:
https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/
https://www.tinnitustalk.com/threads/hyperacusis-as-i-see-it.19174/
https://www.tinnitustalk.com/threads/answers-to-hyperacusis-and-habituation.12058/

 

Thanks Michael, a great post.
I am certainly better than I was at onset, but I think I'm one of the people who won't truly be happy until the noise is completely gone.
I think that comes down to personality in part too, I am a perfectionist and I don't like this flaw....I feel like tinnitus is always the elephant in the room... don't know what it's going to do and have no control over it.

 

Samantha R, I disagree, I think you can overcome it. I am an unbelievable perfectionist, so much so, that a lot of my health problems in the past and present have partly been because of this personality trait.

If I can overcome tinnitus, being a musician and a perfectionist, I think you can too.

 

@Samantha R
Hi Samantha,

Thank you for your kind words they are much appreciated. I am also a perfectionist to the point where it can be annoying at times. I am an Audiophile and have parted with large sums of money over the years, in order to get the best audio equipment that I can afford to hear all the subtle nuances in my music recordings that are on vinyl records and compact disc.

To give you an idea, I have a dedicated listening room that has been acoustically treated to get the best sound from my audio speakers. The mains cables that power my HI-FI are all screened and I use mains power conditioners and filters as most Audiophiles agree, mains electric is full of impurities so has to be filtered to get the best sound from one’s audio gear. Sorry to bore you but I could go on all day if I’m not careful.

I am also a perfectionist in other aspects of my life. For instance, I will draft a letter or a post to a particular forum, at least 6 to 10 times until I’m comfortable with it and this can be frustrating at times. However, everything has to be in balance so I try to curtail this and have toned it down over the years.

Regarding tinnitus. I felt the same way that you do, 20 years ago when I first got the condition, and was determined to beat it and researched it to the hilt in my quest to find a cure. Alas, this never happened and realization came to me one day when I read a newspaper article and it might help you. It mentioned: 19 out of 20 medical conditions cannot be cured. From that moment I started to look at my tinnitus differently and accepted it and gradually, I habituated and got my life back on track.

Take care and wishing you all the best
Michael

 

I'm just the same. Whenever buying products, the slightest imperfections really get to me. Whenever I used to record I had the 'perfectionist take' problem, and would sit all day if need be to correct problems no one else could even hear. When I mix and master recordings I could burn 30 discs checking mixes in every known hifi, car, and system I could get my hands on. All just to find maybe a few frequencies that might resonate just slightly wrong on different speaker types.

I use my ears to transcribe music everyday. Sometimes the slightest details can be lost behind the noises in my head and ears making my job ten times harder. To begin with it was like the end of the world. My perfectionism was nagging me, telling me that the noise shouldn't be there, and ultimately it was making everything just unbearable.

I get really OCD about a lot of things, and probably have some form of it. So giving me loud tinnitus is one of the worst things imaginable. I wanted to die because the crippling effect was so cruel that I saw no way out. I'd never imagine ever overcoming it, but I did.

You have to accept it. Amazing things start to happen when you just drop your guard and stop fighting it.

 

I refuse to be dragged down everyday... So habituation is on its way. I am 29 and I still have much left to do. This has been a huge wake up call for me.

 

I like the way you think @hopeforme . You are positive and assured and that's the best way to overcome tinnitus and get along with life. Well done.....

 

I'm a bit in a similar situation as you Samantha and even if I manage my tinnitus pretty well recently I'm a perfectionist which makes it hell difficult to fully accept this background noise being present all the time with me. I was never able in the past to accept any imperfections either at work or in private, so tinnitus in combination with my personality does not work very well. I live my life, everyday I try not to dwell and self-pity but tinnitus is always kind of irritant which does not allow me to feel fully comfortable in my life.

 

I understand how you feel @Mentos. The habituating process takes time and for each person it's different. Have you considered getting help from a Hearing Therapist or Audiologist as there are various treatments available? Please read my reply to Samantha and then read the post below.
Things will get better and easier.
Michael

Positivity And Tinnitus

For some people prolonged intrusive tinnitus can be very stressful and at times debilitating. This can sometimes lead to depression and a person may need to go on a course of antidepressants. I have often been asked in tinnitus forums and via email “It is great if you’re able to be positive, but simply telling someone to be more positive about tinnitus isn’t going to change anything”. I want to clarify here and now, that isn’t what I mean.

Thinking more positive about tinnitus and bringing positivity into your life takes time it isn’t achieved overnight or by simply thinking to yourself “I must be positive about my life”.

If a person wants to improve the quality of their life they have to be prepared to try and help themselves, because there is no wonder drug or operation that can cure tinnitus at this time. Unless a person faces these facts they will forever be trawling the Internet going from forum to forum complaining why there is no treatment for tinnitus when actually many of these people want a complete cure.

I once read a newspaper article that mentioned: nineteen out of twenty medical conditions cannot be cured. Someone once told me “I don’t want to be positive about tinnitus, I hate it. Being positive wont make it go away". This is true, however, thinking more positive and bringing positivity into your life will reduce the perception on how you relate to tinnitus. CBT and TRT are based on having a positive attitude, without that these treatments aren’t effective.

Long before CBT, TRT and the Internet came on the scene Doctors have been telling tinnitus patients, there’s no cure you’ll have to learn to live with it. Most of us know this is easier said than done.

So how does one start to think more positive about their tinnitus and to bring positivity into their life?

The fact that someone with tinnitus is reading this page suggests to me their tinnitus for today at least isn’t so intrusive that they are unable to function, for that I’m pleased because this is something positive, instead of lying in bed on medication doing nothing. If you are able to work that’s even better as your tinnitus isn’t so severe you’re incapacitated. I see this as something positive in a person’s life. Being able to earn a living and support yourself. Therefore, you’re able to do all the daily tasks one needs to survive in this world. You may have some difficulty granted, but you’re still achieving and that's progress.

It is still better than someone that is visually impaired or severely disabled and unable to earn a living. Or, people with severe tinnitus that are depressed and on medication and unable to work. So by looking at our own circumstances and seeing what we’re able to do and achieve we can think more positively about ourselves. There is nothing more satisfying than being independent and I suggest you hold onto those thoughts.

If you live by yourself consider getting a cat or a dog so your home environment won’t feel so lonely. If you have a partner and family think about spending some quality time with them, as this can help reinforce your sense of belonging, and the love that binds you together, then your T won’t make you feel so isolated. Sometimes opening up sharing your thoughts and how you feel can help immensely and keep negativity at bay.

I have just given a synopsis of what I believe can help a person’s quality of life improve with positive thinking. It doesn’t happen overnight but a lot can be achieved when one is prepared to try. By moving forwards and taking one day at a time you can occasionally look back and see how far you have come.

Michael

 

Thanks to everyone for the interesting dialogue...I too suffer from perfectionism. I suppose a certain amount of it is somewhat necessary in order to keep someone in a practice room 6-8 hours a day for a significant portion of their life.

Ironically, I also remember entire wasted days spent trying to get ALL of the noise out of guitar pedal board, by changing cables, power supplies, adding noise gates, changing routing etc. only to eventually remove all the pedals and plug straight into the amp.

Other than the OCD side of it though, I mostly thought of it as a positive trait in that it pushed me to excel at what interested me. However, since developing tinnitus I have seen the negative side of it not allowing me to emotionally accept anything less than a full recovery. It's sort of like all or nothing. I recognize that this is a dangerous mindset which will lead right down the rabbit hole, and would like to change it. I am interested in hearing about strategies that have been helpful for overcoming perfectionism. Especially from you audiophiles and musicians like Michael and Ed209.

As always, any help is greatly appreciated,

Barry

 

Michael your posts are the best. I have gotten used to dealing with this condition but it definitly has been no picnic. Lots of mixed days but i keep on going. I continue to live my life almost the way i did before onset. Havent touched my drums yet but one day i def will. I would like to ask one thing though and that is if you ever feel any discomfort while attending a loud event such as a wedding. I attended one a week ago and the dj had the bass up and despite the fact that i had my custom plugs on the waves seemed to get through and i could feel a sorness from deep inside my right ear (which is the ear my T focuses in). I took breaks and after the event i was fine. I have rode the loud subways of nyc daily for months and never experienced anything like this. I was curious to see if you did and if this ever got better as time went on. Other than that thanks again for another informative post.

 

Earplugs and earmuffs don't protect as well against low frequency sounds. And custom plugs have lower NRR than foam earplugs.

 

Hi @Jomo,
Thank you for your kind comments. I agree with @TuneOut Earplugs and earmuffs won’t protect as well at low frequencies. Unfortunately some people do not realize this. External sound can still reach the inner ear by bone conduction and I suspect travelling up through the body into the auditory system. It is for this reason some people notice their tinnitus increases after running due to impact underfoot.

When I first got tinnitus many years ago due to noise trauma, I experienced symptoms much like you describe. Things will improve but it will take time. I believe your tinnitus started 9th September 2016? If this correct then in tinnitus terms you haven’t had the condition long, although I fully appreciate that it doesn’t feel that way to you. By all means go out and enjoy yourself but try to be aware of loud sounds, even when wearing earplugs and be careful of low frequency bass. Carry on using sound enrichment especially at night using a sound machine. I advise you to give yourself time for your auditory system to fully recover before returning to playing drums. You might want to ask other drummers on this forum, if there is suitable drum kit available that won't friendly to your ears.

All the best
Michael

 

Interesting. So you are still an active audiophile? Me, I still buy records although it's not so much fun listening with that background noise in the head. However I still keep buying in hope of better times.

Apart from that I wouldn't consider myself a 100% perfectionist. More like in the vain of a hypochondriac. I can feel the cold before it's even there... (and sometimes it won't come...)

I guess I can't habituate anymore as my tinnitus feels so loud (steadily worse). So the people who are able to habituate and have still positivity in them are pretty enviable to me.

 

@friend74
Indeed, I am a very active Audiophile. At this very moment I am listening to one of my audio systems. I have two at home. I am listening to Larry Carlton's CD: Fingerprints played from my computer's hard disc and out-put to my Marantz SA11S3 CD player which as an in-built Digital to Analog convertor that outputs a very high-quality signal to my Valve/tube Bewitch Amplifier that I recently bought. This is connected to and drives my ProAc Reference Signature 8 speakers. The sound is absolutely stunning even if I say so myself through these small speakers, that are placed on Partington Broadside Stands that are filled with lead-shot. There is plenty of attack, the bass is full and the midrange and treble sounds silky smooth without a hint of harshness. That is the wonderful sound of valve/tube amplification. It is an Audiophile's Nirvana!

I am a perfectionist when it comes to extracting the maximum sound quality from my audio systems. I have gone to great lengths to achieve this. Using specialist speakers cables that are thicker than a garden hose and mains and Inter connect cables that cost me an arm and a leg. Yes, I enjoy my music.

When my tinnitus is intrusive, I cannot enjoy my music as I would like but I have habituated and fully accept this, so it doesn't get me down as I know the moment will pass. That's what habituation is, keeping positive even in the downtimes.

Take care
Michael

 

Wow... regarding the fact that this is just ONE of your audio systems. I had a quick overview and yes, that is really an amount of money you spend on your 'hobby'. Those speakers look interesting btw.

So even if you have accepted the condition, can you hear the tinnitus while listening to music or has it gone to the background because of habituation?

 

@friend74

Thank you for your thoughts. My two systems are by no-means ultra high-end but good enough for me and what I can afford. I have finished with the HI-FI buying merry-go-round because if one isn't careful it will take all your money and leave you broke, which is something I have learned.

My tinnitus has large fluctuations in intensity and to get an idea of what it's like, please read my post: My experience with tinnitus, in the link below.

When I am listening to my HI-FI I don't notice the tinnitus as my brain pushes it into the background so I'm able to focus on the music. If your Audio system is good enough and set up correctly, the speakers will completely disappear. By this I mean, when you look at the speakers the sound or music if you like, will seem as if it's coming from behind the speakers. You will get a three dimensional picture/ sound stage. The music will have Hight, Width and depth. All you will hear is the music the HI-FI will completely disappear. Audiophiles calls this Synergy or Audio Nirvana.

All the best
Michael

https://www.tinnitustalk.com/threads/my-experience-with-tinnitus.12076/

 

@Michael Leigh

Cool thread TRT as you mentioned has to be done with the correct Audiologist. Unfortunately the 2 fittings I have had created a bad reaction no different than using ear buds. The first time they drove me to tears. The second time within half hour I could feel "this was not going to work."

I agree in regards to custom ear molds industrial muffs and even wearing them combined. Every time I attempted to drum I would get reactions but it never elevated my baseline permanently.

My tinnitus has been more or less the same where it fluctuates. Recently it did feel like it took a turn for the worse but is settling back down.

Depending on who offers their opinion, theories like the use of headphones, the bone conduction is only driven by fear created your mind. That once you get passed the "distorted thinking" none of it is relevant.

Like carrying on doing everything one would if they did not have tinnitus.

I am more of your opinion when one looks at the physics & mechanics involved if that makes any sense.

I think this is what can get confusing for sufferers.

IMO as though they have a poor way of delivering it. Doctors and ENT's are more or less telling you the truth.

@Jomo do what I am doing in the meantime learn the guitar. Then I can produce my own music.

 

@bobvann

Some people find white noise generators irritating when first used. Therefore I advise the following method to try: Providing the WNG has a volume control, set it to the lowest volume. Wear them for just 1 or 2 hours. Then take them off for the same duration. Slowly build-up the wearing time until 8hrs total wearing time is achieved. This may take a couple of months to reach. If trying to wear them straight-off for 8hrs this often causing irritation and can spike the tinnitus.

My advice for anyone that has noise induced tinnitus. Do not use headphones even at low volume, as there is a risk of making the tinnitus worse.

Michael

 

That does kinda makes sense. I did have the volume set to 1. Problem is as you say it could take several months to build up. Trials for WNG's is typically 30, sometimes 45 or 60 days.

Audiologists tell you to wear them 8 to 10 hours daily right off the bat.

I am really not interested in being stuck with a $5,000 white noise player if it does not help.

It is a fact that TRT or the use of WNG's does not help everyone and has been more detrimental to some.

Same thing we are seeing with Lenire. It is helping some and less others.

That is where tinnitus can get complex and is not "one size fits all."

I have been advised that this is all a waste of time that I will eventually habituate all this will be irrelevant.

From what I am reading this is not always the case. Not everyone seems to be able to naturally habituate.

I did have some interaction with Dr. Nagler on another group. I described my failed TRT attempt. A few remarks he made. 1 - if the audiologist was competent and fitted me properly the WNG's should not have caused me to spike and become unbearable. 2 - One does not need to use the most expensive digital hearing aids to use as WNG's.

However no clinic will work with me unless I purchase $3,600 to $5,800 device.

There is a local Audiologist I talked to a while back that seemed fairly honest. I may revisit this option. Since 1 - there is a trial period and 2 - I can try using them more gradually as you suggest.

I will pretty well know right off the bad if this will be more detrimental rather then beneficial.

Thanks for taking the time. It will be 3 years mid April.

 

Can it spike the tinnitus permanently? How loud are these WNG's from a dB perspective?

 

For me it did not change my tinnitus overall. I stopped using them and returned them the following day. The second time I had not left the clinician's office I sat there with them on for approx 20 to 30 minutes and could tell right away a reaction was coming. Which it did the rest of the day and that night. Then it went back to what it was.

 

I have used white noise generators for over 20 years and never had a problem with them. They should be used under the care of a Hearing Therapist or Audiologist that specialises in tinnitus and hyperacusis treatment and management. Providing their volume is set slightly below the tinnitus and masking it there shouldn't be any problems in terms of spiking the tinnitus. I do not know how loud they can go as in dB and don't believe this is important. They are designed for treat tinnitus and hyperacusis. As I have said, providing they are used correctly they shouldn't cause any problems.

Michael

 

The white noise generators that I use have an adjustable volume control from zero, which is completely silent and increases in volume as it is turned up. I know some WNG have fixed volume: 1,2,3 I do not believe these are adequate as the volume cannot be fine tuned.

Michael

 

So a "slider /turning knob style" vs fixed numbers. One of the members mentioned she has found hearing aids that are helping with a different Audiologist. Did I not read somewhere, that Jastreboff told someone they can use their earbuds? I know some of you did not agree. Is he not the inventor a.k.a. father of TRT?

 

I read that post too and if it is true, I do not agree with Jastreboff recommending earbuds use instead of WNGs. I have his TRT book and he recommends white noise generators which I believe to be right.

Michael

 

Was his book not written in the 80's? Technology of ear buds and phones was not available?

As mentioned there is a trial period with Digital hearing aids.

 

I have his TRT book in front of me and it was first published in 2004. Once you listen to white noise through proper White noise generators, and then listen through earbuds, then you will realize the difference. From my memory, white noise through headphones is crude and abrasive through WNG the sound is much smoother. I haven't listened through earbuds to be honest, so they maybe better than headphones. WNG whether behind the ear types(BTE) or smaller more discrete in-ear models that fit in the entrance to the ear canal are almost invisible.

If you are able to use blue-tooth earbuds without dangling wires and connected to a source that fits in your pocket I suppose they might work. I got my WNGs free under our NHS. These are Behind the ear that look like hearing aids. I also privately bought smaller more discrete in-ear WNG for when I'm away from home. These are the MM10 Smallest white noise generators available: http://www.puretoneretail.net/mm10.html

Michael

 

You can buy programmable digital hearing aids for under $400.00 US on eBay. The problem is one needs a professional to calibrate them and for the counseling portion.

You are lucky they were covered under your healthcare. I have hearing aids option under my extended plan, but it's only $300 every 5 years and we all know what clinic wants for what they use for WNG's.

I know what you mean about white and pink noise sounding crude. Even through my Sony X32 bluetooth speaker some of those noises can become irritating to listen to. I stay away from any form of headphones. As an Audiophile you may get this I have a nice pair of Denons.

As you mentioned on several occasions is it has to be done as per the protocol. I think this is where the failures have been. The 1st clinician is so busy that she took a long time to respond to emails. And just had me on my merry way after 'fitting" them. The second one just wanted me to try them for a weekend.

I have had some clinicians refuse to sell me digital hearing aids, siting my minor to no hearing loss does not warrant it. I don't think they really practice TRT.

 

Aren't you using Lenire?