Breaking The Cycle
So almost 2 years from the first installment of this blog i am finally getting chance to sit down and bring you that long promised next installment - how to break the cycle that maintains tinnitus awareness.
As we discussed previously the triggers for tinnitus awareness are not necessarily the same as the factors that maintain our awareness of it or our degree of distress associated with it. A group of friends could all attend the same gig, most come out with ringing ears but it may only linger and be problematic for one. Why is this? Tinnitus itself is a relatively common symptom, with an estimated 1 in 7 of the adult population experiencing it at some point in their lifetimes. Why are some people bothered by it but others aren’t?
The not so simple answer is that lots of factors seem to play a role in tinnitus maintenance - lifestyle and environment, mood and wellbeing, thinking styles , physical health and hearing impairments can all have a role. The cognitive model of tinnitus awareness proposed by McKenna et al integrates many of these factors. Simply put, initial tinnitus awareness triggers thoughts about what the tinnitus may be or mean which can lead to monitoring of the tinnitus sound, which focuses more attention on it and makes us more aware of it. For some, this can trigger the body’s protective ‘fight or flight’ response. The tinnitus has become ‘tagged’ as a threat and our reflex response is to physically prepare to fight or run away from that threat. This may present as physical stress symptoms like breathlessness, or butterflies but also an increase in tinnitus awareness and sound sensitivity as our senses are heightened to monitor the threat. This cycle of thoughts, monitoring, increased awareness and physical threat response maintain tinnitus awareness overtime. Often we will also change our behaviours to try and improve the symptom for ourselves but this can also backfire and add to the maintenance cycle.
In order to reduce tinnitus awareness we want to break this cycle of maintenance in order to promote the brain’s natural ability to habituate (filter out) to sounds that we don’t need to pay attention to. The more of the elements of the cycle we can address the better.
Threat - It is important to know what tinnitus is and what it isn’t. Arrange to have a hearing test and if recommended medical imaging. Good professional advice about the likely causes of your tinnitus awareness can be very helpful in addressing any underlying worries about what may be causing the tinnitus and inform options for management. In many cases this reassurance is enough to start you on the road to habituation. If worries about tinnitus are more persistent cognitive behavioural therapy has been shown to be helpful.
Awareness - It is very difficult to not pay attention to and think about something that is constantly present in your ears or head. This is where sound therapy or hearing aids are very beneficial. You will know yourselves that tinnitus awareness is worse in quiet places than in background noise. Using ambient or ear level ‘sound without content’ as a buffer to your tinnitus awareness can allow you to focus on other tasks and reduce tinnitus awareness overtime. NB modern sound based therapy does not involve MASKING. In order to habituate to a sound you have to be able to hear it, although in a cushioned way.
Fight or Flight - Tinnitus tends to reflect how you feel physically or mentally at any particularly time. It is likely to be louder when you are unwell, run down, stressed or emotional and less intrusive if you are feeling well and on a beach sipping a G&T. Unfortunately we can’t prescribe beach holidays but anything that helps improve your physical and mental wellbeing can be beneficial in reducing tinnitus distress. Active based relaxation techniques can help calm the bodies fight or flight response and turn down tinnitus awareness. Physical exercise can also be beneficial.
Behaviours - It is natural to try and make changes to help you get through a day (or night) with tinnitus. Common changes include avoiding sound, using ear plugs, checking on tinnitus, researching tinnitus and dietary changes. It is important to know which changes are helpful and which can feed tinnitus awareness.
So the take home message from today’s Blog is tinnitus awareness can reduce overtime, it can become less intrusive and significant and it doesn’t have to change your lifestyle. It is really important to get good advice from a qualified specialist tinnitus audiologist who can check your hearing and help you to develop a management plan suited to your tinnitus experience. We know accessing these services can be difficult at present so we would also highly recommend Tinnitus UK (previously the British Tinnitus Association) who have excellent information leaflets, webinars, help lines and support groups.