Define Severe Tinnitus?

[Tenna]

I came to think about how severe tinnitus is defined. It seems as if there's a general consensus of severe t as being loud. Correct me if I'm wrong, that's the general impression I've gotten from everywhere. However one with an incredibly high vol t can practically not care and one with a very mild t can be on the verge of suicide.
So how is its' severeness actually defined?
If one is truly unbothered by a a very high t can that be considered severe? If one only has t in the silence but is unable t sleep and gets depression/anxiety, is that considered severe?

 

[attheedgeofscience]

However one with an incredibly high vol t can practically not care and one with a very mild t can be on the verge of suicide.

Textbook example. With little relevance to reality.

 

[Tenna]

Anyone with relevance to the question?

 

[attheedgeofscience]

The severity of tinnitus doesn't just depend on the volume. It depends on the kHz-frequency of the tinnitus as well.

It is possible to have tinnitus with a low volume, but which can nonetheless be heard above all background noises (this is the case with the tinnitus that I have had since childhood; doesn't bother me because I am 100% habituated - which is rare and only possible with something which has been present since birth - in my opinion...).

 

[Jay M]

Severity is perception or its actually so loud you have difficulty hearing conversations. Thats my understanding.

 

[Karen]

The way each one of us perceives tinnitus is very subjective.

But, using myself as an example: I had tinnitus for over 25 years, and I considered it mild. Definition: It was not bothersome, did not disrupt my life, and I hardly ever thought about it. I would call that "mild tinnitus".

Then, four years later, an ototoxic drug changed the level of my tinnitus, or my perception of it. It became very loud, roaring at times, and I also developed pulsatile tinnitus. The level of the tinnitus caused me a lot of anxiety and fear, not knowing what was wrong with me. I was unable to sleep, lost a lot of weight, and experienced deep depression and anxiety. I would define that as "severe tinnitus".

 

[Ken219]

@Karen How are you dealing with it? I have tinnitus for 24 years. Had several relapses, but always habituated takes time but I eventually get there. Currently in one now. I'm trying to live a normal life, work, socialize. It is not easy it does break the human spirit but I cry and try. looking forward to habituation.

 

[Karen]

Hi, @Ken219,

It has taken me four years, but I'm dealing with it a lot better now. I have still not totally habituated this time, because I have both pulsatile tinnitus and louder, reactive tinnitus (high-pitched hissing that responds to certain noises). But things have improved quite a bit recently.

I agree that it does break the human spirit, but we cannot let that happen! Try to live your life as normally as possible, and things will begin to improve. Stay strong!!

 

[valeri]

I have a horrible low hum/drone generator like noise in my right ear, for over 2 years now.
Also recently my left one started having higher pitch ringing.
If I could choose I would pick the last one over the drone.
Hum noise has almost a physical feeling to it.
I don't see me ever habituating to something like that or let alone being able to ignore it.
So I would say severity also depends on the noise itself.

 

[RaZaH]

It depends on the noise for sure, my T started as a "wheeee" noise at 3.1 khz and developed into a screeching hi freq at about 14khz , I would give everything for getting the initial "wheee" sound back. The high freq is unmaskable and indeed can be felt almost more then heard . Feels like my brain is getting electrocuted.
I also think volume is a major factor , although it seems obvious it is for some reason debated.

 

[Tenna]

I see. The definition does indeed seem subjective, but is there no clear definition of it? I'm just trying to dig into how it's mainly used, as while a t of lesser vol is considered 'mild', it may have consequences for the individual which can be considered quite severe?

@attheedgeofscience "It depends on the kHz-frequency of the tinnitus as well"
Isn't that quite subjective though? how so

 

[attheedgeofscience]

I see. The definition does indeed seem subjective, but is there no firm definition of it? I'm just trying to dig into how it's mainly used, as while a t of lesser vol is considered 'mild', it may have just consequences for the individual which can be considered severe?

@attheedgeofscience "It depends on the kHz-frequency of the tinnitus as well"
Isn't that quite subjective though? how so

High frequency sounds will cut through anything - and can therefore be heard over anything (even if the volume of tinnitus is low...).

There are official ways to objectively diagnose tinnitus severity using MML standards, I think. Information on this can (probably) easily be found on the Internet or you can ask an audiologist. I just can't be bothered to look through the information; either tinnitus is severe or not - and I don't need a scale of severity to tell me which category I belong to; I know that already...

MML = minimum masking level.

 

[Asian]

It depends on the noise for sure, my T started as a "wheeee" noise at 3.1 khz and developed into a screeching hi freq at about 14khz , I would give everything for getting the initial "wheee" sound back. The high freq is unmaskable and indeed can be felt almost more then heard . Feels like my brain is getting electrocuted.
I also think volume is a major factor , although it seems obvious it is for some reason debated.

How's your lifestyle otherwise ? You suspect anything behind the increase in volume ? Certain medications? Loud music ? Infection? Has it grown gradually over the years or it was sudden ?

 

[RaZaH]

My T did not increase in volume, it has always been loud, what changed was the frequency .
Went from predominantly 3.1 Khz to about 14 Khz. Modulated as well, not one fixed frequency.
However , I do get days where the hi-freq is gone and the "electrocution" of my brain stops.
When that happens I can hear the original 3.1 khz tone, but very low.
Those are my best days, so from that I gather that freq and volume are a huge factor.

Also it just makes sense, imagine this was an outside noise from some machine, the freq and volume would determine tthe "annoyance" factor for sure.

 

[Tenna]

I see @attheedgeofscience , severeness is defined according to MML then. I understand and asked for the general guidelines and way of defining indeed but this raises more questions, is to base such general degree of t on MML not quite narrowed?
About the khz statement again, valeri stated earlier in this post "that the I have a horrible low hum/drone generator like noise in my right ear", and that he'd prefer the high pitch to the low freq, so it still seems more subjective and not just a matter of khz to me.
I'm having a hard time putting t and myself for that matter into perspective and the "either it's severe or not", I mean, when is something severe?

Does severity come down to loudness, khz, the anxiety and depression it brings, the limitations of life, the loss of what you love, socially, professionaly, musically etc?
One could argue severity based on many of those factors, my point is there seem to be a monopoly on severe tinnitus in terms of loudness mainly, while others have gotten or lost many of the above mentioned products of t for a lesser loud.

 

[attheedgeofscience]

I see @attheedgeofscience , severeness is defined according to MML then. I understand and asked for the general guidelines and way of defining indeed but this raises more questions, is to base such general degree of t on MML not quite narrowed?
About the khz statement again, valeri stated earlier in this post "that the I have a horrible low hum/drone generator like noise in my right ear", and that he'd prefer the high pitch to the low freq, so it still seems more subjective and not just a matter of khz to me.
I'm having a hard time putting t and myself for that matter into perspective and the "either it's severe or not", I mean, when is something severe?

Does severity come down to loudness, khz, the anxiety and depression it brings, the limitations of life, the loss of what you love, socially, professionaly, musically etc?
One could argue severity based on many of those factors, my point is there seem to be a monopoly on severe tinnitus in terms of loudness mainly, while others have gotten or lost many of the above mentioned products of t for a lesser loud.

In short, severity comes down to what each of us perceive it as: if we feel miserable about our tinnitus, then it is severe in some way.

The only tinnitus which I would say is definitely not severe is if you can only hear it faintly when plugging your ears in a quiet room. If this kind of tinnitus brings about a reduced quality of life, then I would say there is a psychological component to that person's tinnitus ie. the person is overreacting to it - and should see a professional about it...

I don't have much more to add to this subject. "So sorry..."

 

[Tenna]

That makes more sense = ) ty

 

[tychobrae]

There is a Tinnitus Functional Index which takes into account the volume of your tinnitus plus how it impacts on your life to give you an overall score, but I can't find any indication of what score counts as 'severe'. I couldn't paste a link here but you could Google it.

 

[Tenna]

Ohh, well I tried asking an ENT once but that surely didnt give much hah.
Very well tychobrae, it would just be interesting as you see people talking about the different degrees of t all the time, and coming to think about it it is so incredibly subjective

 

[dan]

I came to think about how severe tinnitus is defined. It seems as if there's a general consensus of severe t as being loud. Correct me if I'm wrong, that's the general impression I've gotten from everywhere. However one with an incredibly high vol t can practically not care and one with a very mild t can be on the verge of suicide.
So how is its' severeness actually defined?
If one is truly unbothered by a a very high t can that be considered severe? If one only has t in the silence but is unable t sleep and gets depression/anxiety, is that considered severe?

Please show me that person. Mind you, that person has to prove their tinnitus is loud, either by tinnitus loudness matching or by a EEG/MEG for tinnitus.
And in order to classify tinnitus as loud, we need to quantify it. TRT clinicians will tell you that by far, most tinnitus is less than 15 decibels above hearing threshold (less than a whisper and is considered soft).
So I would say that loud tinnitus would have to be anything over 20 decibels (above threshold).
Just THINKING your tinnitus is loud, is not proof. Millions of people think their tinnitus is loud and suffer from it just as badly as any severe sufferer, only to find out in a few months that they are totally habituated to it.
Just my educated opinion. And so the story continues...

 

[Jeff M.]

Interesting thread Tenna! (And all contributors!). My two cent opinion on this: the severity of an individual's T should be measured (if we are going to measure) by the level of impact T has on that person's well being.

Volume, pitch, consistency, etc... all contribute to the "severity" of one's T, but now as I consider it, those are not the key contributors of how severe one's T is. It is how severely T negatively affects one's quality of life, that is the standard of measure.

My musings....

 

[gary]

Great question Teena, I think Jeff's reply "It is how severely T negatively affects one's quality of life" Sums it all up.

 

[dan]

Great question Teena, I think Jeff's reply "It is how severely T negatively affects one's quality of life" Sums it all up.

So if I fell down and got a scratch and I say I am debilitated by it, do I need to go on temporary disability for it?

 

[valeri]

For me personally it's the unpredictability of the condition, habituated or not you are never home free, EVER!
That fact, and it is a fact (not distorted thinking), is enough to decrease one's quality of life forever

 

[gary]

valeri, I am not the same person I was before T, not even close...

 

[valeri]

Gary same here, the life I had, the person I was - all gone.
No CBT can convince me that people with t live normal lives. For minority maybe it's possible if t stays the same. But how many think they habituated and then bang.... back to square one.
So no distorted thinking here, facts, reallity....
That's not living, rather surviving.
If a person feels dead despite being tecnically alive I call that severe t

 

[Tenna]

Very interesting to see all of the answers provided here
@dan it seems many do pull out that exact example as existing and many questions its' existence in reality. I guess I just considered like with most of other disorders than the two poles exist.
Alright so you consider the scale of loudness decisive I see.

@Jeff M. I personally think that's a more reflective way to put it. Another thing is it seems to me on one hand defining loud t as severe loads disability and suffering from that scale of measurement to exclusively be where loud t is, while loading t as "mild"/"soft" comes of biased on beforehand.
Suffering isn't given automatically on the two, however more prevalent on the prior yes, yet the terms are loaded on beforehand based on loudness, and not on consequences?
Then again, if a "mild"/"soft" t has vast consequences for the individual, is it then the t that's severe during the time where those consequences exist, or is it the product of t (be it depression etc) that should be defined accordingly as severe? @valeri "If a person feels dead despite being tecnically alive I call that severe t"

 

[Jay M]

My T did not increase in volume, it has always been loud, what changed was the frequency .
Went from predominantly 3.1 Khz to about 14 Khz. Modulated as well, not one fixed frequency.
However , I do get days where the hi-freq is gone and the "electrocution" of my brain stops.
When that happens I can hear the original 3.1 khz tone, but very low.
Those are my best days, so from that I gather that freq and volume are a huge factor.

Also it just makes sense, imagine this was an outside noise from some machine, the freq and volume would determine tthe "annoyance" factor for sure.

You described what I experience! Alternating days with High freq buzzing. In my opinion this type of T is a symptom. Read up on MSG's in processed foods, mono sodium glutamate, its a neurotoxin defined as an excitotoxin. Its a food additive thats in everything processed in some form or alias such as "yeast extract" or "natural flavors". Its terrible for you especially if you have T. Theres a thread on here too. If your body is flooded with this toxin it causes the brain to fire off killing nerve cells. My theory is sleep regenerates these brain cells giving us a normal T day and consuming MSG's in excess kills them off again, hence the high freq buzzing days. I was dumbfounded when i had discovered whey protein powder drinks where full of it in the form of glutamtic acid. I had been drinking a 1.5 serving every morning for a year. For the past 4 days since stopping ive only had one high freq day.

 

[Zimichael]

Yeah, I have to agree with Jeff's summary too...

Volume, pitch, consistency, etc... all contribute to the "severity" of one's T, but now as I consider it, those are not the key contributors of how severe one's T is. It is how severely T negatively affects one's quality of life, that is the standard of measure.

Anyone who has read some of my earlier posts or 'Profile' knows that I have had tinnitus for 58 years, three jumps up from initial volume level, and hyperacusis since 2006 (c/o meds). The 'severity' of each of those transitions was always 'severe' at the time, as I freaked out, went through the usual angst and anguish thinking my life was over, etc. - though as a kid it was a helluva lot easier to get over but in my own 'kid way' it bothered me a lot for a couple of years.

In the first two instances I habituated fairly rapidly and lived a normal life so to speak, though protected against loud sounds after stage II (1980) as an adult. My quality of life after two or three years did not change much compared to before. No-one except my immediate family noticed that I was slightly 'handicapped' so to speak. Some perceptive friends asked why I seemed to sneak over to quieter parts of some event, so they got to know. Basically, the pretty loud internal ringing in my head did not have that much impact on the external life I could live. Thus, my tinnitus was almost a non issue and I only thought about it when, and in, situations of loud noise, or about to partake in them. No biggie. It was a 1-2% issue...So many other fellow humans in much worse shape! Life was good.

Then along came stage III (2006) and the new sister act/brother act of Hyperacusis...This is the > please insert strongest swear word of your choice here < that in my opinion gives the most trouble! Even with tinnitus volume through the roof, it is MUCH, MUCH HARDER to adapt and habituate when hyepracusis joins the equation! It radically affects 'quality of life' and keeps the whole tinnitus anxiety spectrum amped up on over-drive. It took me three times as long to 'adequately habituate' to the even louder tinnitus than I think it would have without the hyperacusis involved. Six years! And even then I had to be much, much, much more careful around sound in general.

This point, about Hyperacusis mixed in with Tinnitus, I respectfully think is not as fully explained, defined, addressed, appreciated perhaps, even on this site, than it I feel it could be. Tinnitus alone, versus Tinntitus + Hyperacusis are sort of two different animals. The tactics for dealing with getting that goal of: 'quality of life' back are similar, but also have significant differences. (Mmmmmmmmm....Maybe I should write a different post on that actually).
I suspect that a majority of people on this Forum, and with T, do not have hyperacusis. Or that is dissipates quickly so does not affect the recovery phase as much. Which is great of course! I mean look at how many people three to six months after coming onto this site in a full blown panic, with new T, are saying goodbye and that life is OK again, and they are moving on. This is what I'm calling 'normal' T. And it's what a lot of the conventional treatments/advice deal with...mostly successfully. People get their lives back. Hence the definition of "severe" gets downgraded from that traumatic, initial: "my life is over!", etc. to: "I can live with this. Things could be much worse!".

So, that definition of "severe", and the absolutely correct aspect of how it affects quality of life, has a big temporal (time) component. Is quality of life affected for a few months? A year? A few years? Forever? There's the rub.
If it's fairly short lived - as horrible as that can be!, then it can even enhance life in some ways by giving an appreciation of what it means to be 'handicapped'. We can gain some compassion and insight into those struggling with physical or health difficulties.
If quality of life is affected 'long term', then it becomes a very different story. And T with H can do that! Or a darn good job of it.

To sum up...Tinnitus IMHO is not that hard to adapt to, eventually. Well, with almost anything but extremely high volumes (and I have that). But add in Hyperacusis, and "severe" almost automatically becomes a part of the condition. After my stage III jump up (when the hyperacusis appeared for the first time), it was only when the hyperacusis died down enough that I could 'adapt' to the tinnitus!
My rough calculation was, that the H eased off about 5% to 10% per year, whilst the T volume stayed exactly the same = loud as hell. So after 6 years, I finally started to get my 'quality of life back' (see "Gangnam Style" video in Positivity Thread, etc.), not because of the change in tinnitus volume, but because of the change in the Hyperacusis!

Well this post is long enough, but I think it is an under-appreciated point and I hope I have shed a little light on it. To those of you with hyperacusis along with your T...please realize that you may have to judge your progress in different terms than those with T alone. Don't feel like you have to meet any expectations, or achieve any milestones, or respond to treatments in similar fashion or similar time-frames.
In particular, this whole thing about not "over-protecting" as it will hold back your progress, etc. Watch out for this one! Yeah it will probably slow it down if you do, but people (even experts/audiologists/whatever) who have not experienced hyperacusis personally, I suspect do not understand this subtle difference and how much more delicately one has to approach the future.
Time, progress, the yardsticks to get back that "quality of life" can be much more challenging and elusive. As some wise person somewhere said: "It's exactly the same, but just different"....Unfortunately, I have had far too much practice and experience of this.

Best to all, Zimichael

 

[Jeff M.]

So if I fell down and got a scratch and I say I am debilitated by it, do I need to go on temporary disability for it?

@dan , it's not if you "say" I am debilitated by the scratch from my fall that would define the severity of the wound. It is the wound's true, actual affect on your quality of life and ability to function normally that would define whether or not the scratch is in fact debilitating.