Hi Mark, I just read your reply on the suicide thread - as well as here - and have to say it's really heartbreaking what you're going through. I feel so sorry for every person who struggles with this each and every day, and that is why we ultimately need a treatment that can bring the volume of the noise down.
Please don't take this the wrong way, but your increases may be due to the horrendous anxiety that you're constantly under. The stress of worrying about what everyday sounds you may encounter is not good for you at all and there are many studies that link stress with tinnitus. This is both as a cause and as a mechanism towards ramping up the tinnitus volume.
Dr Josef Rauschecker is currently trying to raise money to conduct a study that may provide some evidence towards his hypothesis that there is a "gating" problem within the brain of those who have tinnitus. This would likely be comparable to other conditions such as chronic pain. The idea is that chronic stress may change how our brain functions and that signals which would normally be filtered out - before reaching the higher functioning levels like the prefrontal cortex - actually make it to our conscious awareness. This is either perceived as tinnitus and/or pain and may also explain why some have hearing loss but no tinnitus.
There are other studies which indicate further possibilities in which prolonged stress may cause or exacerbate tinnitus. Interestingly, there was a chance for us here at TT to part-fund such a study as one of the candidates for Danny's Memorial Fund was looking at the correlation of blood cortisol levels and tinnitus. We know that having chronically raised cortisol levels for an extended period of time is bad for the body and brain. In fact, it's known that the brain can actually shrink under such conditions and it can also impact upon how memories are stored and retrieved. This is all very relevant to tinnitus as indicated by other studies.
I'll post some excerpts below along with the sources:
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Many people who suffer from tinnitus believe that stress is the cause. And first studies indicate that there is indeed a connection. What is lacking is scientific proof.
The project "Influence of emotional stress on auditory functions" (for short: "Tinnitus and Stress") is contributing to remedying this lack. It draws on research done by the molecular biology research laboratory of the ENT Clinic and the Tinnitus Center Charité.
It is established that chronic stress can, in general, induce and exacerbate changes to the auditory system. They include above all the hypersensitization of auditory perception (hyperacusis), tinnitus, and Menière's disease, a disorder of the inner ear that leads to attacks of rotatory vertigo, one-sided hearing loss, and ringing in the ears.
But how does stress arise? As a rule, it develops when people cannot cope with the growing and/or unexpected demands of their environment. They live under constant emotional pressure. The most frequent reaction is to deny any physical risk in an effort to enhance one's own achievement potential and staying power.
The physical effects of stress include increased production of the stress hormone cortisol. This raises the blood sugar level (gluconeogenesis) and intensifies the breakdown of stored fat (lipolysis), as well as protein breakdown (proteolysis), making more energy available. Higher blood pressure, a high pulse rate, and constipation are the result. But the immune system also suffers. Many patients complain of sleeplessness and a lack of appetite, psychomotor disturbances, and growing feelings of anxiety.
According to Professor Birgit Mazurek, "All these stress-induced mental changes can also influence auditory phenomena, leading, for example to the development of tinnitus or the exacerbation of existing tinnitus. In the ear, cortisol causes a massive release of glutamate into the neurons. This ultimately leads to a greater accumulation of calcium, which damages auditory sensory cells and nerve cells in the ear."
With the "Stress and Tinnitus" project, the Foundation seeks to promote research in this field to develop better individual therapeutic approaches for patients with tinnitus and hyperacusis.
The HEINZ AND HEIDE DÜRR FOUNDATION is contributing € 150,000 over a period of three years to fund the research project."
http://www.deutsche-tinnitus-stiftung-charite.de/en/projects/tinnitus_and_stress/
"We report three novel findings that establish differences between tinnitus participants and controls in terms of cortisol hypersuppression, longer-lasting effects of the DEX test on basal cortisol levels, and hearing discomfort threshold. The first novel finding is that tinnitus participants had more strongly suppressed cortisol levels than controls after pharmacological challenge, despite similar basal cortisol levels. This is consistent with the normal diurnal and blunted response to psychosocial stress in tinnitus participants described in a previous study [23], and supports the hypothesis that tinnitus participants have greater sensitivity to HPA axis negative feedback. Hypersuppression in the presence of normal or near-normal basal cortisol levels has also been found in other clinical populations, such as patients with chronic fatigue syndrome [45–47] and burnout [48]. All these findings are consistent with the notion that basal cortisol and post-DEX cortisol suppression are mediated by two separate receptor feedback systems. More importantly, the suppression effect was independent of hearing loss. This is a key finding, because these factors are difficult to disentangle in tinnitus studies [19, 23], and it argues for a true effect of tinnitus in addition to, but unrelated to, hearing loss. Our findings therefore directly link tinnitus to a stress-related disorder, and not just to a hearing-related disorder, as some recent population studies suggest [12, 49].
The second important finding is that tinnitus participants showed a long-lasting carryover effect of cortisol manipulation. They had lower basal cortisol the day after the post-DEX day assessment compared to the two other basal cortisol assessment days, indicating not only cortisol hypersuppression, but also a longer-lasting effect of DEX administration. Although it cannot be excluded that these findings could be related to slower DEX clearance in these patients, this possibility is unlikely, because there is no rationale for altered liver function in this particular group, which moreover did not differ from controls in terms of age, BMI, or physical or mental health. Furthermore, the carryover effect was observed in the tinnitus participants approximately 36 hours after DEX administration, whereas cortisol and DEX levels should return to baseline 24 hours after oral administration of 0.5 mg DEX [50]. A likely interpretation is that the carryover effect might have been due to HPA axis homeostatic vulnerability, and that hypersuppression might have been caused by increased glucocorticoid sensitivity."
"Subjective tinnitus ("tinnitus") is the perception of sound in the ears or head in the absence of an external sound and difficult to treat. Individuals with tinnitus can experience severe emotional distress, depression, anxiety, and insomnia [1–5]. A recent study in 14,278 adults reported an overall prevalence of 25.3% for any experience of tinnitus in the previous year and 7.9% for frequent or constant (at least once a day) tinnitus [6]. Prevalence increases with age, peaking at 31.4% and 14.3% from age 60 to 69 years for these two tinnitus frequencies, respectively [6]. The increasing prevalence with age is not surprising, because hearing loss is known to be an associated risk factor for tinnitus [7]. With increasing life expectancy, and because hearing loss and noise exposure are increasingly affecting military personnel [8, 9] and youth [10], tinnitus has become a significant public health issue.
Hearing loss predicts tinnitus presence, but not severity [11, 12]. Conversely, individuals with hearing loss do not necessarily experience tinnitus. There is, therefore, a need to determine other factors for this debilitating hearing disorder and its consequences for health in order to better prevent and treat it. One likely candidate is stress. Because stress has long been identified as a trigger or co-morbidity of tinnitus, based mainly on anecdotal and retrospective reports, this idea has been taken for granted in classical teachings on tinnitus [13]. In addition, recent large population studies have established that emotional exhaustion and long-term stress are predictors of hearing disorders, including tinnitus [14, 15]. Functional and electroencephalographic brain imaging studies have also shown aberrant links between limbic (involved in emotions) and auditory system structures [16–18]. Structural brain differences (i.e., grey matter decrease) in tinnitus involving parts of the limbic system have also been reported. More specifically, less grey matter in the nucleus accumbens [18, 19] and the left hippocampus [20] suggests a depletion that could be related to long-term exposure to stress, among other factors."
"Our findings suggest heightened glucocorticoid sensitivity in tinnitus in terms of an abnormally strong GR-mediated HPA-axis feedback (despite a normal MR-mediated tone) and lower tolerance for sound loudness with suppressed cortisol levels. Long-term stress exposure and its deleterious effects therefore constitute an important predisposing factor for, or a significant pathological consequence of, this debilitating hearing disorder."
http://www.biomedcentral.com/1472-6815/12/4
I've had tinnitus since I was around 18 which is most likely from playing in bands. At around the age of 33, it became severe to the point that my brain was full of it. It was an extraordinarily difficult time in my life, so when I read stories like yours I can truly empathise and understand what you are going through. However, mine also became more problematic when I started using earplugs around everyday sounds. Just the fear of thinking about a situation that might occur always had me on edge, and this is not a good mindset to have with tinnitus. I can't pretend to know for a fact what the individual cause or mechanism is in each case because it's such a heterogeneous condition. However, from the evidence we have, it's widely reported that people who overly rely upon earplugs often experience a worsening of their symptoms. This is why clinicians don't advise people to take this route. The reason is most likely down to the overbearing anxiety and stress that one puts upon themselves whilst they are constantly in fear of their environment.
Of course, this may not apply to everyone but it's certainly worth noting. In my case, my symptoms of rising tinnitus and constant spikes improved dramatically when I stopped my over-reliance on hearing protection and addressed my anxiety head-on.
Whatever the situation is with you, I sincerely hope it eventually improves and you get some quality of life back.
I'm so sorry that the people around you are not being mindful of your needs. I think keeping your ear plugs in will be most helpful at work. Have you tried any supplements? For some people, certain supplements work really well. Me for instance, I take Lipo-Flavonoid and it has b-12 and other vitamins that are supposed to support ear health.
Member
) would be to limit earplug use in everyday life and to desensitise your ears gradually rather than shield them. People with hyperacusis are often given sound generators to desensitise their auditory system gradually. This is done by slowly increasing the time they are worn. The advice you are getting here to default to wearing earplugs for prolonged times goes against the evidence we have. People who do this usually find their problems get worse and not better. This is not the same as protecting your ears when you are in an environment that is genuinely dangerous to your hearing. This would be places that have a constant background noise above 80 dBA and even then you would have to be exposed for many hours. The higher the background decibel level is, the shorter your safe exposure time would be (which I'm sure you already know). With tinnitus, many get stuck in a feedback loop and are constantly in a state of fight or flight. Over time, you are conditioning your brain to respond to sounds - that you have a negative association to - in the form of a spike. This may not be the case for everyone, I have to point this out, but it certainly is for the vast majority. Earplug use can easily spiral out of control if one is not careful.
