What is Reactive Tinnitus?

Discussion in 'Support' started by Michael Leigh, Sep 27, 2016.

    1. Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      What is Reactive Tinnitus?

      A word often used in tinnitus forums these days is: “Reactive” tinnitus. People affected will say something like: “ I have habituated but my tinnitus is reactive to certain sounds” or “ I have reactive tinnitus”. I believe there is some confusion here 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 the 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.

      Inside the human body is 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, risks making their tinnitus more intrusive as the brain and auditory system never switch off. 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. A person might not notice this immediately as it’s usually a gradual process.

      When we are in deep sleep a sound machine 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 (slightly below 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.

      Michael
       
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    2. Jomo

      Jomo Member

      Tinnitus Since:
      9/4/16
      Cause of Tinnitus:
      going for a rim shot on the snare drum.
      good post...i agree with this...although new to it, i believe keeping sounds around me has helped a lot
       
    3. stophiss

      stophiss Member

      Location:
      Florida
      Tinnitus Since:
      April 2016
      Cause of Tinnitus:
      too full a life
      Mike,
      I currently sleep with no background sound in quiet. I don't have trouble sleeping as my tinnitus isn't too intrusive or...I have always been an easy sleeper and I just go to sleep even if my T is moderate. I don't recall losing sleep because of my tinnitus. I am not sure if I am even fully habituated to my tinnitus. I tune it out a good portion of the day depending how idle or focused I am on a project. For example when I was watching the pres debate last night and texting my friends for their input, its like I didn't have tinnitus.

      Do you have a suggestion for a sound machine...something cost effective to place on say a night stand or dresser?
       
    4. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      @stophiss
      It sounds like you have low tinnitus and are able to live with it quite comfortably. Try to keep it that way by limiting headphone use or better not using them at all. Keep away from loud noise and if you go to clubs always have noise reducing earplugs with you - I don't mean the foam type as they block out all the sound.

      It is good that you are interested in using a sound machine and I advise that you do. Sound Oasis make the best, as they are made for people with tinnitus: http://www.soundoasis.com/ You get what you pay for and if you want quality you won't find better than sound oasis sound machines. They make quite a few. Model S-650 is popular and the best is S-5000.
      Best of luck
      Michael
       
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    5. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
    6. foryourinfo

      foryourinfo Member

      Tinnitus Since:
      Long time
      Cause of Tinnitus:
      Something
      I think the only confusion there is might reside inside your own head. Subsequently, you might be adding to the confusion here on the board because of your outdated regurgitated knowledge. There is in fact a term called "reactive tinnitus" - and no, it is not the same as hyperacusis. You might want to check out some of the literature such as the article below (and also some of the material by Dr. Salvi):

      www.health24.com/Medical/Hearing-management/Tinnitus/An-overview-of-Tinnitus-patient-management-20120721
      I seem to have found quite a few mistakes regarding your knowledge in just one day. I hope I didn't over-complicate the plot for you.
       
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    7. Ed209

      Ed209 Member Benefactor

      Tinnitus Since:
      07/2015
      @foryourinfo, it's interesting that it says to stay off the Internet, which is standard audiological advice (usually). It's also a firmly held belief of mine that when one is in the acute stage, the Internet can be a bit of a double edged sword. It can offer immediate support, but it's usually at the cost of increased anxiety and behavioural obsession.

      The scientific community does not have a complete understanding of tinnitus. What we have is a scattered picture of different pathologies, representing a broad spectrum of symptoms, and believed mechanisms behind them. No two peoples tinnitus is the same which highlights the complexity of it all.

      Most of us here are well read when it comes to this condition, but that still doesn't make us experts (although we have a deep understanding because we have it). In fact, the experts aren't really experts, because they also don't fully understand it yet. All we can do is try to help each another, and to be honest that's all Michael is trying to do whether you agree with him or not. You have to bear in mind that he uses his free time to try and help people.

      I don't agree with everyone here, and I know for sure that everyone doesn't agree with me, but that's how it should be. We are free to express our thoughts and opinions based on our real life experiences.
       
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    8. foryourinfo

      foryourinfo Member

      Tinnitus Since:
      Long time
      Cause of Tinnitus:
      Something
      No. He uses he his free time on Tinnitus Talk because he has nothing else to do with it. Which tells me all I need to know.
       
    9. PaulBe

      PaulBe Member Benefactor

      Location:
      Cairns
      Tinnitus Since:
      11/2013
      Cause of Tinnitus:
      Probably sound, though never proven
      I actually have what I would call "reactive" tinnitus some days, and I also have hyperacusis. They are easily separated in my experience as two quite distinct entities. I've thought about this more than I'd like to and that's how it seems.
       
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    10. Tinker Bell

      Tinker Bell Member

      Location:
      U.S.
      Tinnitus Since:
      02/2017
      Cause of Tinnitus:
      SSHL from viral infection
      What do you feel are the differences between your hyperacusis and reactive tinnitus? I'd appreciate the opinion of someone dealing with both.
       
    11. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      No such thing as reactive tinnitus. It was a term made up in tinnitus forums. Reactive tinnitus is in fact Hyperacusis. Hyperacusis comes in different levels of severity. If hyperacusis isn't treated and cured tinnitus will always be a problem and often manifests itself by "spikes" or sensitivity to sound.
      Michael
       
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    12. Ed209

      Ed209 Member Benefactor

      Tinnitus Since:
      07/2015
      Some audiologists today are starting to recognise reactive tinnitus as a seperate issue to hyperacusis. I know a few years back there wasn't any real 'official' recognition for it; it was deemed an invention of the forums. I did have some reactive components to my T at the beginning; I probably still do but it's subtle, and I've got some hyperacusis since my ETD/glue ear got out of control.

      I'm no expert, so I'm going to stay out of the official definition of what's really going on, and leave it for you all to make your own minds up. However, I'll post an excerpt below (along with a link) which may help:


      Reactive Tinnitus
      Reactive tinnitus is a smaller subset of the overall tinnitus population. It is a type of tinnitus that is worsened after exposure to mild to moderate levels of sound. Typical tinnitus, if there is such a thing, is made worse by loud music, loud yard tools, loud traffic, street noise, et cetera. However, a patient with reactive tinnitus will tell you that their tinnitus is worse after they get out of the car or the shower. Most tinnitus patients find a lot of refuge in the shower; they like that constant sound. These patients do not. This increase in sensitivity tends to last for more than one day. It is a subset of the overall tinnitus patient, but one of which you need to be aware and know how to identify.

      The best test for identifying reactive tinnitus is the Residual Inhibition test that you will do as a part of your overall tinnitus evaluation. The procedure for that test is presenting narrowband noise at the tinnitus frequency for about one minute at a sensation level of about 15 dB over the threshold at that pitch. You will then turn the noise off and ask the patient if their tinnitus has changed any. Some will say it is the same. There are those that will say that it has increased or it is worse. That can be a red flag of the presence of reactive tinnitus.

      Also on the patient history, you will find a report of overuse of hearing protection when not indicated. These people are wearing hearing protection to the grocery store or at the gas station, or during times when they otherwise would not need to be protecting their hearing. They have also found that nothing will reduce their awareness of their tinnitus, and they may have had other trials with acoustic-based treatments that have aggravated their tinnitus. They may have tried hearing aids unsuccessfully and needed another option instead.

      The Neuromonics Oasis product has a two-stage protocol. We have a reactive tinnitus protocol for these patients where you would begin the patient in Phase 2 and complete their treatment using just that phase of the therapy.

      Hyperacusis
      Another difficult tinnitus patient can be one who has decreased sound tolerance or hyperacusis in conjunction with their tinnitus. Decreased sound tolerance is discomfort from sounds at a level which most people would not find uncomfortable. The guideline is loudness discomfort levels below 90 dB. Hyperacusis is when the patient experiences sounds that would normally be considered loud, but easy tolerated by other patients. This patient would perceive sound to be painful or very loud. There is some physical discomfort that many of these patients experience. As a guideline, LDLs are typically below 70 dB across all frequencies. We recommend testing 500, 1000, and 4000 Hz in the tinnitus frequency to give you a good basis for their discomfort levels.

      How does decreased sound tolerance or hyperacusis affect treatment? The literature reports that anywhere from 8% to 50% of these tinnitus patients will report decreased sound tolerance or hyperacusis. If you do not address this issue first, it will be very difficult to achieve any headway in managing their tinnitus. For example, let’s say you are providing sound therapy as a tinnitus therapy for decreased sound tolerance and the idea there is to give them relief, relaxation, and sense of control. If they are not able to tolerate that sound therapy at a volume loud enough to get relief from the tinnitus, you will not be able to effectively treat the tinnitus. You need to effectively address the hyperacusis first, and then you can begin to address the tinnitus goals.

      In terms of expectation management, you need to lay out realities for the patient; they must be on board with those and understand the process of treatment. Then they can follow recommendations, and you will be on the same page. That can be a frustrating exercise if you begin what you think is treatment for their tinnitus, and then you run into brick walls when it comes to their decreased sound tolerance. These are my favorite patients to treat, because many times they have become withdrawn and disconnected from a lot of things they enjoy and love. To give them the ability to go back and experience those things again is very powerful and rewarding.


      http://www.audiologyonline.com/articles/your-role-in-treating-tinnitus-12792
       
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    13. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Thank you for the information @Ed209 Most people that have noise trauma also have some sensitivity to sound. If this sensitivity doesn't cure naturally or isn't treated and cured the sensitivity remains and will always be a problem even after someone habitutes to the tinnitus. The auditory system needs to be desensitized as the report you've supplied says. It is something that I've always said. A lof of people that experience this "reactive tinnitus" which I still have doubts about, will go once the auditory system is desensitized. This is best done using sound enrichment or preferably white noise generators.
       
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    14. Tinker Bell

      Tinker Bell Member

      Location:
      U.S.
      Tinnitus Since:
      02/2017
      Cause of Tinnitus:
      SSHL from viral infection
      I was just about to post the same article!

      Plus through some quick searching I found the slides of a Mayo Clinic presentation on tinnitus and one of the bullet points was: why do some patients have reactive tinnitus.

      I don't know, but if such a highly regarded and ranked hospital in the U.S. is using the term in discussions among doctors, then I think it might be on the way to be a recognized term/condition.

      Sometimes terms start online and become part of our society's vernacular. Perhaps doctors are noting that as well as noting minor differences between the two.
       
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    15. Ed209

      Ed209 Member Benefactor

      Tinnitus Since:
      07/2015
      Yea I agree. It's now becoming officially recognised in the literature. This is a fairly recent development, even though people have been complaining about 'reactive tinnitus' for years.
       
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    16. CarloZ

      CarloZ Member

      Tinnitus Since:
      September 3, 2015
      Do you happen to know anybody who has habituated to reactive tinnitus? I've acquired it recently and I'm so damn scared I'll never get used to it.
       
    17. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      @Ed209 Thanks again for the report but I suspect they are promoting their Neurommonics Oasis product and using fancy jargon to fool people. A sales pitch to buy into their treatment to treat and cure "reactive tinnitus" I believe sound enrichment or using white noise generators to desensitize the auditory system will suffice if it doesn't cure naturally. In any event, sensitivity to sound will remain a problem if it is not treated.
      Take care
      Michael
       
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    18. cantbelieveit

      cantbelieveit Member

      Tinnitus Since:
      Forever
      Cause of Tinnitus:
      Not sure
      the Mayo Clinic has got nothing to do with Neuromonics [staff: vulgar language removed].
       
    19. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Your auditory system needs to be desensitized @CarloZ It can cure naturally or by using "sound enrichment" . In more severe cases, the wearing of white noise generators might be needed.
       
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    20. light rain

      light rain Member

      Location:
      Eastern TN
      Tinnitus Since:
      2010
      Cause of Tinnitus:
      unknown
      I had H before T so did it cause it somehow since.mine is not noise induced. I know about masking but I also have had long standing auditory processing issues and I really think a sound machine pushed things over the edge. Even if they are nature sounds something drives me nuts listening to it from a device. I've even been annoyed by a gurgling rain gutter because my mind will be trying to "translate" it like I often have to do with regular speech. (I of course know there is nothing to be translated, it just becomes very frustrating.)

      I'm also looking up info on vestibular H since my episodes of dizziness don't seem to have a pattern except perhaps noise. I do have nerve damage though so maybe not related. Not looking for medical advice - I'm going back to the ENT this month. Just looking for info to consider if there is any to consider about APD in the mix with the H and T.
       
    21. Ed209

      Ed209 Member Benefactor

      Tinnitus Since:
      07/2015
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    22. Ed209

      Ed209 Member Benefactor

      Tinnitus Since:
      07/2015
      To be fair, it seems to be misunderstood, and experts do contradict each other. However, it does seem to be more 'officially' recognised now.
       
    23. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      @Ed209 I will PM you in a moment.
       
    24. Tinker Bell

      Tinker Bell Member

      Location:
      U.S.
      Tinnitus Since:
      02/2017
      Cause of Tinnitus:
      SSHL from viral infection
      Ha, I was trying to figure out what the Mayo Clinic is selling. Health? Academic progress in the medical field? Better identification and treatment of medical conditions?

      I can personally attest that the place isn't cheap, but they're certainly worth every penny!
       
    25. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Anything to do with healthcare isn't cheap Tinker bell when one has to pay for it. Here in the UK we do not pay for healthcare and therefore, I feel a sorry for people in certain parts of the world that do. I believe, these so called health professionals, have found away drum up business by using the term "reative tinnitus" that is so often used in tinnitus forums, and will treat using some new method of treatment, which is no more than using "sound enrichment" to desenstize the auditory sytem. I therefore expect it is going to be quite expensitve.
       
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    26. Tinker Bell

      Tinker Bell Member

      Location:
      U.S.
      Tinnitus Since:
      02/2017
      Cause of Tinnitus:
      SSHL from viral infection
      Is not healthcare in the UK paid through taxation? So in theory, UK residents (at least most I would think) are paying for healthcare via their taxes. I'm okay with paying a very reasonable amount via my private insurance.

      And no, the Mayo Clinic does not need to use the term reactive tinnitus to drum up business. :LOL: It is often regarded as one of the best hospitals in the world and consistently ranks #1 in the U.S. in a variety of specialities.
       
    27. AUTHOR
      AUTHOR
      Michael Leigh

      Michael Leigh Member Benefactor Hall of Fame

      Location:
      Brighton, UK
      Tinnitus Since:
      April /1996
      Hmmm I seem to have struck a sensitive chord yesterday. Our health system doesn't quite work the way that you've said. I'll leave it at that.
      Michael
       
    28. Tinker Bell

      Tinker Bell Member

      Location:
      U.S.
      Tinnitus Since:
      02/2017
      Cause of Tinnitus:
      SSHL from viral infection
      Then how does the government cover healthcare costs? It's free at the point of use with the government as the single payer, but everything I've read says the government then pays for it through general taxation. I realize this is a tangent, but it's confusing. Can anyone from the UK address how the government covers healthcare costs?

      https://en.m.wikipedia.org/wiki/Healthcare_in_England

      It's kind of like how in the US we pay for infrastructure like roads. I do not personally write a check to a road construction company, but the government does and covers those costs through taxes.
       
    29. GregCA
      Jaded

      GregCA Member

      Tinnitus Since:
      03/2016
      Cause of Tinnitus:
      Otosclerosis
      The answer is here. General Taxation mainly.
      That's how governments' "free" services are often funded.
       
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    30. Tinker Bell

      Tinker Bell Member

      Location:
      U.S.
      Tinnitus Since:
      02/2017
      Cause of Tinnitus:
      SSHL from viral infection
      Thank you! Nice to see that I was in part quite correct.
       

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