Determining Tinnitus Amplitude

[jumping jack]

How do you determine whether you have the loud kind of tinnitus or the mild, or even quiet case, in an objective manner?

I'm only a day-old sufferer, and at this stage, I perceive the whine I hear as though it's coming from a steaming teapot that is give-or-take 20 feet away. The pitch, as best as I can figure it out, is at around 11KHz.

How does your tinnitus manifestation compare?

Is what I'm experiencing on the "oh, you lucky bastd" end of the spectrum, or should I expect a tougher time habituating and tuning it out (assuming this thing doesn't stop)?

 

[Owen]

I think most would class that as very mild. Hopefully, it is such that your brain will tune it out. For the more severe sufferers, a teapot about 2 inches away is a good day!

There is no correlation between perceived amplitude and emotional distress though - it is tough at the start, irrespective of how severe it is or isn't. Do look after your hearing though.

It's interesting to me that you mention dental work. I had to have some done yesterday and I did keep thinking to myself how ridiculously loud the drill sounds. I know a lo of i is conducted, but never the less, I think I'll take earplugs next time.

 

[maltese]

IMHO It's best not think about that. The more you care, the more intrusive it might become, so just relax for now. It was just 1 day!

(over 2 weeks here)

 

[jumping jack]

@Owen -- Thanks for the info! In your case, wearing earplugs will not help with the sound that is conducted via the jawbone (which is how I got the ear-splitting jolt that I think got my ears ringing), and may even be detrimental, since the pressure waves may not have a clear escape path (please, don't read this as medical advice; it's more of an educated guess). The earplugs will only help with external sources of noise.

@maltese -- I wish I were on week 2 so I'd already know if the d@mn thing had subsided or if I'm stuck with it for the remainder of my days. It sure would be nice for it go away on its own. As is, it's an emotional rollercoaster, and my concentration is in the dumps. I guess this is as good a time as any to get in a better mental health shape; we'll see what the ENT has to say tomorrow. How do you cope now that you've had a couple of weeks to deal with T?

 

[Owen]

As I said, I know a lot of it is conducted, but there is still an awful lot of noise carried through the air. As such, I still believe it more effective to wear them than not.

I wouldn't wear blocking earplugs anyway, musicians earplugs still have a hole through, it's just very narrow.

Since you're visiting the ENT tomorrow, my advice is to set your expectations reasonably low. If you are fortunate enough for it to go, it'll be your brain that figures it out, not the ENT.

 

[GregCA]

How do you determine whether you have the loud kind of tinnitus or the mild, or even quiet case, in an objective manner?

The most objective manner that I know of is using a tinnitus loudness matching technique (usually done with an audiologist, along with pitch matching). We establish how many decibels the patient perceives the tinnitus sound at. It's not perfect since we rely on the patient to assess the loudness rather than sample the data independently, but it's the closest I know.

My rule of thumb is to determine severity/intrusiveness based on the ability to mask it. For example, if you can't hear your T most of the day because of ambient sounds, and you can only hear it at night or in a quiet room, then I'd classify that as "mild". If you can hear it everywhere and nothing can mask it, then I'd call that "severe".

While the level of distress may seem independent from loudness/intrusiveness, as there are people with mild T who feel a lot of distress about it (you'll find examples of those on this very forum), and the other way around, I read in a study that there is positive correlation between loudness and distress, which seems quite intuitive to me.

 

[jumping jack]

@GregCA -- Thank you for the thorough answer. My own, uninformed, take is also that the perceived amplitude should correlate with distress levels.

I'm still on day 2 of the T experience, so it has yet to settle down to something I could call an average. Here's what I've noticed during this short time:
- when I'm cleaning the dishes, the running water provides an effective mask for the ringing noise (and has made an enthusiastic dish-washer out of me);
- street noises (in the high-density city where I live) also cover the ringing, although if I bother to isolate it, which at this stage I am wont to do nearly all the time, I can still make out the whine;
- putting on headphones and playing a 11KHz tone (not even loud) cuts the in-the-head whine for the duration the tone is played, and even for a few seconds afterwards.

Subjectively, I don't perceive the T as being overtly loud; mostly, just annoying. It's the thought that I'm stuck with it with no way out that I find distressing (plus there is the work-related and general life stress which amplifies the psychological effect).

 

[jumping jack]

On a related note, would the perceived amplitude of the ringing determine the course of treatment / therapy, assuming the cause of the T is neuronal / cochlear damage?

 

[Tyler Montgomery]

id say get in the shower, and let the water hit you straight on top of the head. If you still hear it clearly, then it's pretty loud.

 

[jumping jack]

@Tyler -- The shower actually calms it down, even without the water hitting my head.

 

[Tyler Montgomery]

If you cant hear it over the shower, then don't even worry, that means you can mask it with music, or just background noise. It will be super easy to habituate.

 

[jumping jack]

Thanks for the encouraging words! I did run a few experiments earlier today using my headphones, and I was able to mask it using various methods (e.g. using a low-level 11KHz tone, the sound of rain, etc.). I didn't want to potentially damage my hearing even more, so I've put the headphones down until I get an exam by an ENT and have a treatment plan in place.

 

[Tyler Montgomery]

This probably won't make any sense to you at this point, and you probably will not ready to embrace this idea until you are a few months down the path...but the best thing to do is stop even trying to measure your tinnitus at all. Don't think about it, don't talk about it. Don't sit and wonder each morning if it is louder or softer than the day before. Don't read a bunch of stuff online, or go see a bunch of doctors. After a few months of not giving any attention to the tinnitus, you will realize that you don't even notice it hardly.

 

[jumping jack]

Thanks for the strategy tip! Is that how you managed to put a lid on the T in your case?

 

[jumping jack]

Also, how did you handle the first few months before finally learning to stop paying too much attention?

 

[Tyler Montgomery]

I just learned through exhausting every possible option, and spending a lot of money too.

There are plenty of doctors out there with lots of ideas on how to treat tinnitus. They will offer you counseling, they will offering you medications, they will sell you programs that can create sounds to mask your tinnitus, they will even sell you hearing aids that produce sound to mask for you...that will cost you thousands.

It is the natural reaction when a sound abruptly starts in your ear, to battle it viciously and try to get it to go away. So, you will be very willing to listen to anyone who says they can "cure" you.

In my experience, everyday that you battle the tinnitus, is one more day longer before you start to actually heal yourself. I will let you on a secret...none of the "cures" for tinnitus do anything to help you.

What does work, is to totally ignore the tinnitus. You have to completely disrupt your thought process every single time your brain tries to think about tinnitus at all. You can't talk about it with anyone. You have to literally pretend that it does not exist. After you do that for about 6 months straight, then you will feel considerably better. When I was trying to fight the tinnitus, I worried about it every second. It controlled me 24/7. Now, a year later, the tinnitus is exactly the same, but I can go hours, sometimes an entire day without even noticing it.

 

[jumping jack]

Yes, at the moment it does feel like a grain of sand in my eye that I can't blink away.

Thanks for the exhaustive advice. One of the first things I read on the topic of dealing with T was very close to how you approached it -- a guy on his blog wrote that you basically have to treat the T just like you would wearing yellow pants, i.e. accept it as though it's part of your personal attire and pay no unnecessary attention to it.

I expect my ENT visit to primarily exclude (or identify) other causes for the ringing. After having read enough about various treatments, including your words, the only medicine that will help me out is my own head.

And, congratulations on putting normalcy back in your life!

 

[jumping jack]

P.S. Don't know if this is meaningful or not, but since reading some of the positive vibes/ideas in this thread, and in others on this forum, and trying to get on with life's and my work's needs I'm feeling a good deal better now. Obsessive self-monitoring, followed by self-pity that combined go round and round in a circle is what leads to the constant distress.

 

[Tyler Montgomery]

Honestly you're doing way better than I did. I freaked out for the first few months. I had to take time off work, thought my life was ruined, drank heavily to be able to sleep. Now, the tinnitus is EXACTLY the same as it was then, and I think about it maybe 3 or 4 times a day for about 30 seconds and am slightly annoyed.

So basically the point is, even though tinnitus annoying you right now, you will get to where you don't care about it much at all. The sooner you stop fighting against it, the sooner you will get to the point where it is part of you and you are not bothered by it.

 

[maltese]

@maltese -- I wish I were on week 2 so I'd already know if the d@mn thing had subsided or if I'm stuck with it for the remainder of my days. It sure would be nice for it go away on its own. As is, it's an emotional rollercoaster, and my concentration is in the dumps. I guess this is as good a time as any to get in a better mental health shape; we'll see what the ENT has to say tomorrow. How do you cope now that you've had a couple of weeks to deal with T?

I'll just give a brief description of my first 2 weeks (IMPORTANT NOTE: initially I could hear my T over pretty much everything, it was super intrusive):

Days 1-7: A lot of crying. Missed classes. Screwed up tests. No way to concentrate. Panic attacks just after waking up.
Days 8-14: It's almost 2 weeks, it might stay forever!? *crying*. Missed classes. Reading EVERYTHING on tinnitus.
Day 15: If I don't pay attention...
Day 16: ..it's not so bad...
Day 17: I can do this! Many (few minutes long) periods when I don't even remember I have T. They usually end with my brain going "hey, why is it so quiet??!"


I don't have an idea if physically there is ANY improvement. But my ability to concentrate starts to come back, I'm not depressed anymore. Of course, I'm not habituated yet, there is a long road ahead of me, but it's ok!

What changed on day 14-15? I realised that there is no difference between "I don't have T" and "I don't hear my T". I started sleeping with quite shower sound and hence I started to sleep well, without waking up with a panic attack. I stopped hoping T will go away. Whatever happens - it's not the end of the world, I still can do all those things that make me happy! Imaginary sound taking away my happiness? No way.


You'll be fine. You will forget about your mild T in few weeks. Just protect your ears in the future.

 

[jumping jack]

@Tyler -- Yikes. Those were some troubling months you had to go through, especially when it comes to the bottle. Though I'm a near teetotaller, and can't claim first-hand knowledge, I realize how a mixture of exasperation and drinking can potentially lead a person down a one-way dark path (I hope this won't come out sounding patronizing). How is your work life now? Did you get your old job back, and were you able to regain your ability to concentrate and be as productive as you were befpre? Is your sleep back to normal or, at least, adequate levels? My job requires near constant concentration (I'm a freelancing software developer), and that is what I want to recover first, after spending a panicky first day barely able to hold things together (it also gives me hope for the future). After that, it's getting into a good, restful sleeping habit (I am a flaky sleeper to begin with); right now, it's so much easier to stay awake with my mind at 100% power, so I don't even bother trying go back to bed after the little bit of sleep I get.

@maltese -- That sounds like it was a harrowing time you had during those 2 weeks. Glad to hear you're on the path to mental recovery. Like in your initial response to T, I'm still mostly on board the worry train, though I manage to catch some breaks here and there, trying to keep the obsessive thoughts at bay and stay focused on life's needs and wants. Strangely, the T subsides when I lie down to sleep in the evening, but I can still only get a couple of hours of wink time before I wake up, whether from worry or otherwise, and the sensation returns. I even seemingly experienced a few minutes of silence after waking up a short while ago, which was a real treat. Is the soothing sound you play the only thing you use to stay asleep? Did you initially try anything else, e.g. medication? Myself, I'd rather stay off meds, especially the psychoactive ones, if possible; I'm not terribly confident the potential side-effects and/or withdrawal symptoms will be simple to handle. I will probably read up on CBT to see if and how it can help with the insomnia.

And a question to both of you (and anyone else who'd like to chime in) -- have you been dealing with this challenge on your own, or did you seek out a therapist or a group therapy setting to get some outside help and/or perspective? Perhaps, you sought help from a loved one or a close friend? If you did, how did it go?

I haven't yet disclosed my condition to anyone else, save anonymously to those of you on this forum. In my short time here, I've found that the forum and the people here provide a helpful substitute for group therapy sessions (not that I have been to any such sessions before, but I imagine they're a lot like our conversations here, but in real time).

I bid g'night/g'day to everyone. I'll see if I can catch a few more winks before the morning.

 

[maltese]

And a question to both of you (and anyone else who'd like to chime in) -- have you been dealing with this challenge on your own, or did you seek out a therapist or a group therapy setting to get some outside help and/or perspective? Perhaps, you sought help from a loved one or a close friend? If you did, how did it go?

Mostly on my own. Didn't want my family to worry. I applied for university provided counselling too, no response so far heh.

Is the soothing sound you play the only thing you use to stay asleep? Did you initially try anything else, e.g. medication?

No medications. I actually managed to sleep without it but I would wake up very, very early in the morning, feeling like crap. Playing some soothing sounds changed that drastically, I sleep 98% normally.


PS I hope I didn't sound too pessimistic in my previous posts, my point was that even though my T (according to what you wrote) is a bit more intrusive, I'm coping with it ok and it's not affecting me that much anymore You seem to be coping so much better than I did!

 

[jumping jack]

Yeah, worrying family members (spouses not included) is probably not the good idea until you've got a reasonable grip on the situation, or unless you're sure your family will be understanding and not try to interfere to your detriment.

While I did have a positive mood trend going last evening, it went away as soon as I woke up after only 2 hours of sleep. That triggered some rather unpleasant panicky moments, and any chance of going back to sleep evaporated. So as of now, with little rest and feeling groggy, I have yet to find my optimistic self again (some ongoing work stress is no help, either). I have my daily exercise later in the afternoon, and I hope that will give me a boost like it appeared to do yesterday.

I will need to do some reading up on strategies for staying asleep, and I will try your idea out, too. You seem like you have made peace with your situation. Good job!

 

[Tyler Montgomery]

Yeah I did manage to get my work under control. I was not very productive for about 6 months, but I did what I could to make ends meet. I work in a fairly quiet office, so dealing with the ringing was very difficult there. Of course I still hear it while in the office...but instead of feeling panic and fear when I hear the ringing, I just think "oh there it is. That's slightly annoying." Then I forget about it after 20 seconds and don't think about it for a couple hours.

Sleep is totally fine now. It maybe takes an additional 10 minutes to fall asleep now but other than that my sleep is normal. I did have to use sleeping pills and alcohol at first in order to fall asleep, so that I would not let my life totally fall apart. I am not suggesting hitting the bottle, but I will tell you that when I drink, I don't even hear the tinnitus at all...so some whiskey at night was a great short term solution. As for my long term solution for getting to sleep and staying to sleep, I got a fan and turn it on every night and I use an app on my phone called relax melodies. I would really recommend getting the and playing around with the different sound combinations on there. I put the app on with a mix of white noise, rain, and wind sounds and put it right next to my head at night.

As for your other question, I did take the approach of reaching out to family members and friends to try and get some dialogue going about tinnitus and I also wanted some sympathy for my suffering. I would not recommend doing this.

The more you talk about tinnitus the louder it is, and the longer it takes to get it to fade away from your focus. Keep in mind, the ringing that we hear in our ears is not a real sound. This stuff is totally fabricated by our brains. It is only as loud as you allow it to be.

In my opinion, go to a specialist to get all the info you need about how loud your T is to you at the moment and what frequency it is. After that, just stop talking about it completely. Don't tell anyone about it who is going to come back and bring it up again to you once you start down the path of habituation. When people are constantly asking if you're doing any better and what they can do to help, it's just adding time to your habituation process because they are forcing you to continue monitoring and focusing on your tinnitus.

 

[jumping jack]

@Tyler -- Thanks for the detailed response.

I am apprehensive about using alcohol as a sleep aid (I worry that if it helps me I may make a habit out of it), but I did get some herbal pills that are supposed to do the job, and I'll try them out this evening. After 2 essentially sleepless nights (preceded by a stressful week) I am caving in, and going the medicine route. The mobile app you suggested looks pretty good; I'm currently setting up a melody combination for tonight.

Re: informing relatives and friends -- for now I'll keep this to myself (being single helps), and will decide when and to whom to disclose it later. I agree that with the habituation goal in mind it's better to leave others out of it, so that I don't have to report my progress, or lack of, on a regular basis.

By the way, do you find participating in this forum has helped you out with your goals? Does (or did) it have an effect on your habituation progress?

 

[Tyler Montgomery]

I used this forum just to read about what was happening to me, and get some advice right at first. Then I did not log on here for about 9 months. Checking this forum everyday will almost certainly stop you from habituating. Once you are in the frame of mind to start your habituation process, you should probably just stop logging on here. I think you're way too early on for that though. You need to wait at least a month to see if it will just go away randomly.

 

[jumping jack]

Got it. Makes sense. And thanks for your helpful input.

I do think at this initial stage I need to collect as much information as possible (and the encouragement I have received has been of great help, too), before I start the letting-go phase.

 

[Tyler Montgomery]

Yeah you will be fine, one way or the other.

Maybe you will get super lucky and your tinnitus will just magically go away. If not, you will not care about your tinnitus in a year.

 

[maltese]

That triggered some rather unpleasant panicky moments, and any chance of going back to sleep evaporated

Classic. It was the same with me. This will stop happening, don't worry. You can make sleeping easier by playing some (quiet) white noise/nature sounds.

 

[jumping jack]

Happy to report that I caught some sleep last night (not quite the 7+ hours I'd have liked, but it's something). The herbal sleeping meds might have helped. My anxiety and worry levels were significantly reduced.

I notice it's not so much the ringing in my ears that troubles me, and I've pretty much accepted the constant whine is to stay with me. It's my stress levels from other aspects of my life (especially, work-related stuff) together with the still remaining obsession over T that combine to result in a self-amplifying anxiety that can quickly escalate into panic mode. At this time, I may be overly sensitized to even the smallest trigger which ends up hurling this emotional avalanche on top of me. I must still be reeling from the initial shell-shock, and I hope re-establishing life's routines and improving my social life and sense of worth will help alleviate this vicious cycle.

Related to what I mentioned above about getting rid of self-pity, and boosting my perception that my life has a meaning outside of simply surviving I am strongly thinking about getting involved in some kind of regular volunteer work, or even adjusting my current work to part-time status at some point, so that I can dedicate the other half of my workweek to another endeavor. I currently (and have been for some years now) work from home, with little, if any, social interaction during the day. The workload can be unpredictable, which I believe has led me to feel isolated and unimportant aside from my work accomplishments; many years ago, I worked at a job that had me interacting with different people throughout the day, and I have fond memories of those times. Yesterday, I visited an ENT, and while I was walking around the hospital, and generally observing the goings on inside I felt this strange desire to be one of the staff members (perhaps, not the receptionist...). Later, when I saw the doc, I discovered she was the most friendly and approachable person I had met in a long time (I find docs usually try to get you in and out of the office in as short a time as possible). So combine that with her job helping people out (which I enjoy doing very much when I have the chance to and when I'm not in a funky mood), and I was dreamy about the place in no time. I guess becoming a doc is impractical at this point (late 30's here), but there may be other such positions, whether in a hospital environment or somewhere else, worth exploring. To conclude this mildly rambling thought chain, I think I need to change certain aspects of my life if I want to start enjoying it some more. The T might be a setback, but it also just might be the spark that helps me improve my lot in life.