FACTS ABOUT TINNITUS & Habituation
Thoughts, what CBT therapists call "cognitions"—beliefs, assumptions, judgments, expectations, etc.—have a strong influence over feelings and behaviors. If your thoughts about tinnitus are negatively affecting your emotional state, you’ll want to be very certain that those thoughts are valid and reasonable. In the throes of tinnitus distress, it’s common to be influenced by emotion-driven fears, myths, misconceptions, and downright bad advice. A healthy perspective on tinnitus is based on actual evidence derived from carefully controlled research, and, where research is lacking, a sound scientific rationale, backed by clinical observation. Here are some important facts to consider:
Facts About Tinnitus
- The most common type of tinnitus (99%) - sensorineural - is harmless.
- One out of every six Americans (15%) has sensorineural tinnitus – that’s about 50 million people.
- Sensorineural tinnitus is not a progressive condition, that is, tinnitus does not inevitably get louder over time.
- As many as 40% of people with tinnitus also have hyperacusis or other type of sound sensitivity.
- Some cases of tinnitus fade within six months of tinnitus onset.
- Ninety-eight percent (98%) of people with tinnitus, often following a period of emotional adjustment, are not bothered by their tinnitus.
- No one knows the internal cause of tinnitus. The prevailing theory points to damage to auditory receptor cells in the inner ear (hair cells), though some cases of tinnitus appear to originate in the brain itself.
- External causes of tinnitus include head injury, sudden or prolonged exposure to loud noise (rock concerts, dance clubs, motorcycles, shop tools, construction sites, firearms), and a very short list of medications.
- There is no evidence that exposure to noise levels below 85 dB (most restaurants, street noise, health clubs) makes tinnitus worse.
Facts About Tinnitus Distress
- About one out of three (33%) people with tinnitus develops tinnitus distress.
- Most (95%) people with tinnitus distress are mildly to moderately impaired. Only about 5% (1 in 20) report severe, prolonged distress.
- Surprisingly, there is only a small, nonsignificant association between levels of tinnitus distress and tinnitus volume and pitch.
- About one half (50%) of people with tinnitus distress have been or are currently depressed.
- About one third (33%) of people with tinnitus distress have been or are currently diagnosed with an anxiety disorder.
- About one half (50%) of people with tinnitus distress mistakenly believe they are “going deaf.”
- About one half (50%) of people with tinnitus have trouble sleeping.
- Contrary to expectation, suicide is uncommon in tinnitus populations. One study found the rate of suicide to be lower than that in the general population.
Facts About Treatment for Tinnitus
At present, despite the many claims, sensorineural tinnitus is not a treatable condition:
- There is no evidence that dietary supplements, including Gingko Biloba, reduce tinnitus.
- Two studies found that Gingko Biloba had no effect on tinnitus.
- There is no evidence or scientific rationale for eliminating caffeine, salt, or alcohol.
- There is no evidence that treating TMJ resolves tinnitus.
- There is no evidence that acupuncture or sacro cranial therapy reduce tinnitus.
- There is insufficient scientifically derived evidence to support TMS, AM-101, laser and hyperbaric oxygen therapy for tinnitus.
Facts About Treatment for Tinnitus Distress
Treatments for tinnitus distress are intended to reduce the emotional distress and dysfunction associated with tinnitus. These approaches are not intended to have any effect on the volume, frequency, or pattern of tinnitus itself. The goals are reduced emotional reactivity and reduced tinnitus awareness:
- Cognitive Behavior Therapy (CBT) is the most researched approach to tinnitus distress, and is supported by numerous scientifically controlled studies. Taken together, these studies show that on average two out of three people benefit from CBT for tinnitus. This makes CBT the closest thing available to a true, clinically proven program for helping people recover from tinnitus distress.
- There are fewer scientifically controlled studies of Tinnitus Retraining Therapy (TRT). These results support the counseling component, but are inconclusive regarding the benefit of in-ear noise generators.
- There is insufficient scientifically derived evidence on which to recommend other forms of sound therapy for tinnitus distress.
Facts About Habituation
- The vast majority of people with tinnitus – 98% - go on to habituate
- Habituation is a simple form of learning in which a person decreases or ceases responding to a stimulus following a period of exposure.
- Habituation occurs gradually, over time, as the brain's threat detection center—the amygdala (əˈmiɡ-də-lə)—learns the signal is unimportant, that is, has no adaptive value.
- Habituation occurs in all five senses. For example, people commonly habituate to eyeglass frames, visual backgrounds, ambient noise, perfumes & colognes, even passing trains and flight traffic.
- Habituation parallels desensitization, the state in which a stimulus no longer produces an emotional reaction following a period of exposure. Through desensitization the signal becomes emotionally neutral. Desensitization has occurred, for example, when hearing your tinnitus no longer triggers distress.
- Habituation does not reduce tinnitus volume, however, there is often a subjective sense that tinnitus is quieter, as the sound is experienced as less "intrusive" and is easier to ignore and forget.
- Habituation is not all or none. Most people still hear their tinnitus at times. Clinical observation suggests quiet settings and periods of stress are linked to greater tinnitus awareness.
- There are no scientific studies tracking the typical course of habituation to tinnitus. A common estimate for transitioning from "bothered" to "not bothered" is six to eighteen months.
- The path to habituation can be a jagged, marked by ups, downs and setbacks. On average you can expect a gradual reduction in attention and emotional reactivity to tinnitus over the first several months. This pattern may continue for another year or so before leveling off.