Tinnitus the Symptom and Habituation

[MattK]

Dr Nagler,

I really appreciate your time here helping us sufferers. It really shows that you're a very caring doctor. I've really enjoyed reading a lot of your material on your website about tinnitus. One interesting concept, and it makes a lot of sense to me, was that you said that since tinnitus is just a symptom, it's possible to not know you have the symptom... I'm not saying this right I don't think... like you're analogy that if you have a rash, an itch might be a symptom of the rash. But often we don't know we have the symptom until something calls our attention to it, so in essence, we don't really have the symptom. So that made me curious, if someone is as habituated as they can humanely be, does that mean in essence they do not have tinnitus until something draws their attention to it? Like I know you've said that your tinnitus requires no effort at all; none to ignore or anything. So if someone came up to you and asked you if you have tinnitus, what would you say?

Also, one more thing I wanted to get your thoughts on. I think I am progressing well with my tinnitus, but I must admit that I am a little paranoid about it getting worse for no apparent reason. I've read on the forums a few times now of people who have been habituated, but then for some reason it got worse, and now they are back to square one. Does that mean they weren't fully habituated? If yours suddenly got even worse, how d you think you would handle it?

 

[Dr. Nagler]

One interesting concept, and it makes a lot of sense to me, was that you said that since tinnitus is just a symptom, it's possible to not know you have the symptom... I'm not saying this right I don't think... like you're analogy that if you have a rash, an itch might be a symptom of the rash. But often we don't know we have the symptom until something calls our attention to it, so in essence, we don't really have the symptom. So that made me curious, if someone is as habituated as they can humanely be, does that mean in essence they do not have tinnitus until something draws their attention to it? Like I know you've said that your tinnitus requires no effort at all; none to ignore or anything. So if someone came up to you and asked you if you have tinnitus, what would you say?

I do not know that a person who has truly suffered from severe intrusive tinnitus can ever reach the state you describe. For me, I can hear my tinnitus whenever I try to hear it - but I don't ever try to hear it because ... well who in his or her right mind would!!?? And every once in a while - totally unpredictably - I become aware of my tinnitus for a few moments or minutes even though I don't try to hear it. At those times it can distract me for sure and interrupt my thinking, but it causes me no distress.

Now I think you are asking me if - since tinnitus is a subjective symptom - in my opinion do I have tinnitus during the times that I do not happen to be aware of my tinnitus. (Similar to not itching unless you are aware that you are itching.) My answer to your very good question is a clear and unmistakable: "I don't care." And that, my friends, is habituation.

...............

Also, one more thing I wanted to get your thoughts on. I think I am progressing well with my tinnitus, but I must admit that I am a little paranoid about it getting worse for no apparent reason. I've read on the forums a few times now of people who have been habituated, but then for some reason it got worse, and now they are back to square one. Does that mean they weren't fully habituated? If yours suddenly got even worse, how d you think you would handle it?

What would I do if my tinnitus suddenly got louder? (Which is what I assume you mean by "worse.")

I never gave it a thought. I guess if it bothered me, I'd break out my 20-year-old broadband sound generators and wear 'em for a couple of weeks. Like re-learning how to ride a bike. No big deal if you have a good strategy. And, for me, TRT was a very very good strategy!

Hope this helps more than confuses.

Dr. Stephen Nagler