Habituation: What Can I Expect in My Case, with a Loudness Match of 20dB SL?

[Bartoli]

Hi Dr. Nagler

I'm one year into severe tinnitus. Not much has changed apart from the distress and panic attacks. It still controls much of my life and wreaks havoc on my sleep and concentration and ability to work. I went to the ENT last week and got a loudness match of 20dB SL (she used narrowband noise around 8kHz, while my tinnitus is a lot higher, up in the 12-14kHz).

She stated that this is a very high number. I already know my tinnitus is bad from my reaction to it. Since then though, I feel that it's somehow proof that habituation is not really possible for me. Or at least, that I'm already doing well seeing the circumstances. But I'm devastated.

Almost no one has more than 10dB SL loudness match, and here I am with double that. What should I realistically expect? I feel like I have the world's loudest tinnitus.

 

[Dr. Nagler]

Hello @Bartoli -

Thank you for your interesting question.

Let me first address the issues surrounding your 20dB SL tinnitus loudness match. You wrote, "Almost no one has more than 10dB SL loudness match," but that statement is inaccurate. In actuality more than 60% of the tinnitus population has a loudness match of 10dB SL or greater when their tinnitus loudness was measured as yours was - at a frequency substantially lower than the frequency of their tinnitus. While the largest study (more than 1000 participants) that looked at tinnitus loudness matches in dB SL showed that 2.6% of more than 1000 participants had a loudness match of 19dB SL or greater when the testing was done at their tinnitus frequency, almost 24% had a loudness match of 19dB SL or greater when the testing was done at a frequency lower than their tinnitus frequency (in that part of the study the investigators chose to use a frequency of 1 kHz). Your 20dB SL loudness match was performed at a frequency (8 kHz) lower than your tinnitus frequency (12-14 kHz) - and if you compare apples to apples, there is a sizable portion of the tinnitus population with a loudness match equal to or greater than yours.

But more importantly, to the best of my knowledge it has never been shown anywhere that the tinnitus loudness match correlates with habituation. Hard to believe, but true! And that actually makes some sense, since habituation is all about how you react to your tinnitus regardless of how loud it might be! Perhaps you might think about habituating to tinnitus as a concept rather than to tinnitus as a particular tone.

I realize that you are having a difficult time with habituation, but I suspect that the reason has little or nothing to do with the loudness of your tinnitus. As to the question of what you can realistically expect, in my opinion you can realistically expect to do quite well once you have identified and adequately addressed the factors that are inhibiting your progress, likely none of which has much to do with loudness. That process can take some time, and many (including myself way back when) have found it helpful to work with a knowledge and experienced tinnitus clinician in that regard. But it all starts with having good information - and when you say that you feel like you have the world's loudest tinnitus, you may be basing that emotionally-charged conclusion on bad information.

Hope this helps -

Stephen M. Nagler, M.D.

 

[Dr. Nagler]

@Bartoli, some of the wording in my original response may have been unclear. I have cleaned it up a bit, and I hope it now makes more sense. Please take another look.

All the best as you move forward -

Stephen M. Nagler, M.D.