What Happens After Habituation?

What happens after habituation?

People that have had tinnitus for while, usually under a year, have often asked me this question as they look forward to the day they will habituate. Some wonder will they habituate to the point where they no longer hear the tinnitus? Will they be able to do everything as they did before the onset of the condition? Going to the movies, the gym or attending a nightclub. Listening to music through headphones and whether it’s necessary to continue using sound enrichment at night? There are many questions surrounding tinnitus and habituation, hopefully, I’ll be able answer some of them.

When tinnitus is severe and intrusive and a person has had to seek help at ENT, it can become quite a complex condition to treat. Therefore, it can be difficult to be specific and say how a person will feel and what they’re able to do once habituation is achieved, because one rule won’t suit everyone. Another thing to keep in mind is that many things can cause tinnitus. So, I will try to narrow things down a little and focus on the most common cause of it, which is exposure to loud noise. Again, we are all different, so my suggestions are for guidance only should anyone wish to try them.

Some people believe habituation means they will no longer hear the tinnitus but this is incorrect. However, it’s true that for some people their tinnitus has reduced to such a low level they hardly ever hear it. By contrast, others hear their tinnitus buzzing away in the background and can live quite contently doing all the things they want to because their brain has learned to ignore it, and that’s what habituation is – learning to live with something. It takes time but can be achieved by most people even if your tinnitus spikes occasionally.

I see no reason why a person can’t go out and enjoy themselves at a nightclub or the movies providing they take the necessary precautions and wear noise-reducing earplugs. They won’t impair sound quality but will reduce external sounds to a safe level when in a noisy environment. They are readably available, reasonably priced and discreet. When using gardening equipment such as a petrol lawn mower or electric power tools I advise using ear defenders.

Quite a few people have contacted me saying their tinnitus has become worse during and after running, and over time noticed it become more intrusive so have had to stop. I believe this more than just coincidence. My theory is, running on hard ground or on the treadmill causes impact underfoot and this travels up through the body towards the head and auditory system. The vibrations might be irritating the cochlear making the tinnitus worse. I have no doubt not everyone will be affected in this way but it’s something to consider if you notice your tinnitus getting worse after a run.

The same applies when at the gym, see how you feel on the equipment that you use and adjust your workout accordingly. I use an elliptical/cross trainer machine and haven’t noticed any adverse affects. The reason might be, while using it my feet don’t make contact with the ground so no impact is felt or transferred up through my body.

Headphone use and tinnitus has caused many discussions in tinnitus forums. Some people are adamant that they do no harm as long as the volume is kept low and some ENT doctors agree with this. Others like myself including ENT doctors believe they shouldn’t be used even when listening at low volume. As previously mentioned, my focus is on tinnitus that was caused by loud noise exposure. I believe once the cochlear in the inner ear has been damaged by exposure to loud noise, it is much more sensitive to sound and therefore headphones shouldn’t be worn. I have counseled too many people that habituated to tinnitus, returned to using headphones and noticed their tinnitus becoming worse even when the volume is kept low.

A favourite buzzword used in tinnitus forums is: “Reactive” tinnitus. A person affected will usually say: “ I have habituated but my tinnitus is reactive to certain sounds”. I have seen this word mentioned many times in tinnitustalk, but I believe there is no such thing and will explain.

Someone that has tinnitus especially when caused by loud noise exposure, hyperacusis (sensitivity to certain sounds) is often present. If hyperacusis isn’t treated then their auditory system will always be sensitive to certain sounds, even after habituation has been reached. It is for this reason the use of white noise generators (wngs) is recommended to help desensitize the auditory system. White noise generators are used as part of TRT (tinnitus retraining therapy) and must be adjusted correctly as not to irritate the inner ear (cochlear) when wearing them. This treatment is best done under the care of a Hearing Therapist.

When a person says they have “reactive tinnitus”, in my opinion, they are not aware they have hyperacusis, which is causing their tinnitus to spike when they hear certain sounds. Although hyperacusis can improve by itself with time, without treatment there is no guarantee. For this reason I often recommend a person to use sound enrichment (sound therapy) as it helps to desensitize the auditory system.

I believe anyone that has tinnitus should use a sound machine especially at night because the brain and auditory system never switch off. There are mixed feelings about using sound enrichment at night but the benefits are often realized once a person stops it.

People have contacted me saying they’ve noticed their tinnitus starting to become more intrusive after they have habituated for a while. I usually ask if they are continuing to use sound enrichment at night. Often I’m told they have stopped using it thinking all was now well. Inside the human body can be a noisy place but our brain has learned to filter out much of this sound so it doesn’t focus on it. Anyone with tinnitus that sleeps in a quiet room after habituation risks making their tinnitus more intrusive. If the brain hears silence while we sleep, it has the ability to increase its background activity and at the same time increasing the tinnitus making it louder and more intrusive during the day and night. A person might not notice this straight away, as it’s usually a gradual process.

A sound machine does its magic while we are in deep sleep. It supplies the brain and auditory system with sound enrichment. Over time, the tinnitus is pushed further into the background making it less intrusive and will help make the path to habituation easier. It is usually best to have the sound machine playing in the background at a low level (below the level of the tinnitus) without drawing attention to itself unlike a radio. For this reason music is not the best source to use at night as it draws attention to itself.

I believe once a person habituates to tinnitus they should try and carry on with their life doing all the things that they want to and take precautions when being around loud sounds.

Michael

PS: Habituating to tinnitus often seems shrouded in mystery but I don’t believe there’s anything mystical about it. We all habituate to different levels because tinnitus comes in many forms and intensities and no two people experience it the same. Some people have large fluctuations in their tinnitus and every day is a different experience. At times this can be difficult to live with and medications may be required to help cope with the condition. This type of tinnitus is one of the most severe but habituation is still possible, to an extent but does present additional problems.