Tinnitus Relapse After Two Years of Habituation: Any Advice & Support for Me?

Hey all. My tinnitus onset was in early October of 2018 (age 28), due to listening to very loud music with over-ear headphones (not to mention years of playing loud music). Bilateral, very high-pitched, much like an electric buzz/hissing, with a tone slightly lower and tonal also accompanying it in my right ear. No significant hearing loss, according to an audiologist. I would have called the intensity at its worst an 8.5/10 and at its best a 6/10. I went into a very deep depression and thought my life was over. As a musician who had recently made the decision to pursue a career as a session guitarist full-time, this was especially gut-wrenching. But with the use of ear-plugs and noise apps on my phone (I did use earbuds for these apps, which I now know is not a good idea), I was able to habituate within 6-8 months. I used notched sound therapy, rain sounds, and white noise to mask when the tinnitus was at its worst, and this helped me immensely.

The next two years were very good. I began to pursue other dreams that weren’t music related and I’ve led a normal life, hardly even noticing tinnitus. I even recall times where someone would mention tinnitus and I’d consciously say to myself “Oh yeah! Wow… I almost forgot I have it.” I got back into the restaurant industry (which, in hindsight, was probably a louder environment than is ideal for a tinnitus sufferer) in order to pay the bills, and I did begin to listen to music in headphones at a low volume again, which I’ve obviously learned now was probably not wise.

After two years of habituation and leading a normal life, I began to experience a flare-up in late May/early June of this year (age 31). It truly did ramp up gradually, as I went from moderately noticing my tinnitus more to eventually noticing it 24/7 again over the course of a couple of weeks. I initially expected this to be a temporary flare-up, however it has now become a full relapse. Two months later, it seems to have remained constant and I am probably in one of the lowest states I’ve been in since I acquired tinnitus in October of 2018. I’d consider the intensity about a 9/10 most of the time, with a 7/10 being about the best it has gotten, for maybe a day at a time. I’ve become increasingly depressed and am now very concerned that my working environment is only making matters worse, as I still work in the restaurant industry in a pretty loud place (anywhere between 75-85 dB at any given time). I currently wear ear-plugs every day there, but I’m worried that can be counterproductive if done too much. I’ve now learned more about tinnitus in the last two months than I ever did in the first two years after onset, and am just worried that the increase in intensity and my foolish decisions to return to a louder working environment/using headphones have done irreversible damage to where I won’t be able to habituate again.

So, with my full story out of the way, I come here seeking advice, and I come here seeking hope. I have read many of the posts by @Michael Leigh about habituation, and his lengthy struggles with habituation, and they have certainly given me some insight. This is mainly directed at anyone who has had to habituate more than once or has had relapses in their tinnitus. I have a few questions for you, as I am now trying to carve out my new path to habituating once more.

1.) For those of you who have had similar relapses and had to habituate more than once, what were your experiences with your second round of habituation?

2.) I have never taken an antidepressant, and never considered myself a depressed person before the original onset of my tinnitus. I considered starting on antidepressants during my initial onset, but I was able to notice improvements organically before getting to that juncture, thus talking myself out of it. What ADs are recommended and how have they helped you through your tough times?

3.) At what point should I consider TRT or white-noise generators to help cope? What are the best devices for tinnitus?

4.) Should I be concerned about my work environment, even with earplugs? My shifts last anywhere from 6-9 hours, so I’m plugged up for the duration. Should I be worried about the occlusion effect if I’m wearing earplugs and talking often? I am a server, so I’m constantly talking to people. My work environment is anywhere from 75-85 dB (may reach 90 dB on a crazy weekend night) at any given time, so I’m afraid to NOT wear earplugs, but also afraid of what overplugging/occlusion can do. This is my biggest hurdle, currently.

Any help/advice/hope would be appreciated! I do subscribe to the idea that tinnitus is heavily influenced by your mentality, so please, I would prefer only positivity in response to this thread. Thank you in advance!

 

Unsure about your other questions, but I am currently taking 15 mg of Mirtazapine, and I've found it very beneficial at getting me to sleep, as well as quieting the tinnitus sometimes (though that part is irregular). My mood is only slightly improved, but my dose is for sleep. Higher doses will have a more antidepressant effect.

The only side effect for me that I hate is the weight gain, but my metabolism has always been pretty good, so it's only slightly impaired otherwise. It's also going to be pretty difficult to taper off of it. But besides all that, it's been a real lifesaver. Sleep is vital when it comes to tinnitus, for me at least.

Good luck and take care!