Will I Ever Habituate — How Do You Ignore a Sound in Your Head?

[Kells]

Hello Dr. Nagler:

I first want to thank you for being so giving of your time. I have read through so many of your answers and you've been so helpful to people. I wish I had a doctor like you.

My question will be about habituation.

A bit of background... I'll try to be brief. My tinnitus started in May 2019, three days after flying home from a vacation. I was just sitting watching tv and it started. For the most part of last year I was caught up in the WHY, which I know is not helpful. I've backed off on that and am trying to chalk it up to "life happens." In that quest, however, I saw 3 ENTs, including one at the University of Michigan, 3 audiologists, GP, dentist, a chiropractor and a physical therapist for my TMJ. No answers. However, my hearing is normal on the standardized test. One audiologist, who has a tinnitus clinic, tested me further and I guess I have some high frequency hearing loss. I'm 49 so that wasn't surprising but, for my age, my hearing is excellent according to the University of Michigan audiologist. After two horrible experiences with ENTs my experience with the doctor at University of Michigan was very encouraging and I felt so good after seeing him. He said he was sure I would naturally habituate in 9-12 months. Of course my mind is my worst enemy, because I doubt it all the time.

I did see a psychologist for 6 months and instead of CBT, he recommended Dr. Howard Schubiner's Mind Body Program. I did that program through their office and while I worked out some things from my childhood, etc., it didn't do anything for my tinnitus or how I view it. It's not my therapist's fault because he introduced me to meditation and mindfulness but it's hard to do those things with all the hissing I hear.

My tinnitus is "variable." I will have a quiet day where I only hear it in silent rooms (those days feel like heaven to me), followed by a noisy day where my whole head hisses and buzzes. I've had weeks where it would fall into an every other day pattern. Now it's all over the place. I never know what the day will bring. It's been 8 months since I got T and I can't stop focusing on it. My husband, brother and three very close friends all have tinnitus, are habituated and they all say "ignore" it. How can you ignore something that you can hear over everything? I do my work and hear it, I drive and hear it, I read and hear it, I watch tv and hear it. How do you ignore a sound in your head? It's the first thing I hear when I wake up and the last thing I hear when I go to bed. I don't know how people ignore that or make peace with it and I am so afraid I will never become habituated. Is there any hope for me?

 

[Dr. Nagler]

Hello @Kells. Thank you for the kind words.

You asked:

How can you ignore something that you can hear over everything?

I have no idea. But (fortunately!) habituation has nothing to do with "ignoring" your tinnitus. Habituation has to do with not caring about your tinnitus. If you don't care about your tinnitus, there is no need to ignore it, there is no need to deal with it, and there is no need to cope with it.

Let's use a very loud external sound for an analogy ...

There are people whose homes are near railroad tracks - but they are hardly ever aware of the trains. Somebody comes to visit and wonders, "How in the world do you handle that racket? A train goes by every 20 minutes or so!" And the folks living near the tracks, whose hearing is just fine by the way, say, "I don't know. I just don't hear it."

So the question is, what are two things that a fellow who lives near the railroad tracks can do to make sure that he hears most every train going by? Well the first is obvious: If he purposely tries to hear the trains, he will hear most every train. The second might not be so obvious: If he purposely tries not to hear the trains (i.e., if he purposely tries to ignore the trains), he will hear most every train. No, the reason he is largely unaware of the trains is that he pretty-much doesn't care. And that's what habituation is about: Not caring!

So the harder you try to ignore your tinnitus, the tougher it becomes to habituate your tinnitus. At least that's how I have come to see it.

Is there any hope for me?

I don't see why not. But it might require a slightly different strategy. A good first step, in my opinion, would be to try to identify and effectively address your "Barriers to Habituation." I will attach some suggestions in that regard to the bottom of this post to help get you started on your way.

All the best with it -

Stephen M. Nagler, M.D.