Tinnitus is a condition in which the sufferer perceives (‘hears’) a loud and persistent sound in their ears that is not produced by any external sources.
Most frequently the sound is a high-pitched whistle, hissing, buzzing or roaring sound and it may be very loud or just sitting in the background.
Tinnitus is thought to affect around 15% to 20% of the population and is more common in older people.
Tinnitus can be caused by ear damage, exposure to sustained loud noise and circulatory conditions. There is also some suggestion that, in recent times, that Coronavirus vaccines may have also led to Tinnitus as a side-effect and symptom of ‘Long-Covid’.
For some sufferers the intrusive sounds associated with Tinnitus may be present all of the time and for others, they may notice is less frequently and only be aware of the sounds periodically.
At the present time, despite ongoing research, no definitive ‘cure’ for Tinnitus has been identified.
Tinnitus is NOT a psychological condition in itself, but may give rise to secondary problems if not managed effectively.
You may also like to visit the British Tinnitus Association website here.
Although most commonly described as a ‘ringing’ sound, Tinnitus can also lead to other sounds being perceived such as:
Because Tinnitus is only ‘heard’ by the sufferer it is sometimes known as ‘Subjective Tinnitus’ meaning that it cannot be measured ‘objectively’ – in other words, by a third party.
There is one form of Tinnitus that is related to a person’s circulatory pulse which is known as ‘Pulsatile Tinnitus’ which can sometimes be ‘heard’ during medical examination (usually by stethoscope) and so this form of Tinnitus is often referred to as ‘Objective Tinnitus’.
Objective Tinnitus may respond to medical interventions if the primary cause is physiological and can be corrected though medication.
Secondary Symptoms of Tinnitus
In common with most chronic conditions (problems that persist over lengthy periods of time) the sufferer may go on to suffer secondary symptomology, particularly problems with Anxiety and Depression, as a result of there being no immediate forms of relief from the ringing noises.
Tinnitus is also associated with broken sleeping patterns (Insomnia) and poor quality of sleep which are known to lead to higher levels of stress, anxiety and depression.
People cope with Tinnitus in various degrees, with some people finding it a fairly minor or irritating issue whilst others find the ringing noises to be so intrusive or pervasive that they suffer emotional distress.
In this sense, the impact of Tinnitus can be said to be ‘subjective’ and dependent upon the ‘meanings’ attributed to the problem by the sufferer.
Because the experience of Tinnitus is predominantly subjective, psychological therapies such as Cognitive Behavioural Therapy (CBT) have been clinically demonstrated to help sufferers manage their symptoms more effectively by changing the meanings they attribute to their experiences.
Tinnitus Severity Classification
Academic researchers have devised a five tier classification system for grading the (subjective) severity of Tinnitus in individual sufferers as follows:
- Catastrophic – Tinnitus sound is present on a constant basis and is regarded as being beyond any conscious control. Catastrophic Tinnitus can lead sufferers to feel very anxious, depressed and helpless. Sleep is likely to be significantly affected and the quality of day-to-day life may be diminished.
- Severe – Once again, the ringing sounds are most likely to be constantly present although the sufferer may be able to cope more effectively on a day-to-day basis although with a reduced ability to maintain focused attention on demanding cognitive activities. Sleep is also likely to be affected.
- Moderate – The Tinnitus sounds may be perceived and noticed during normal daytime activities, especially those in which background and peripheral noises levels are low. Sleep may be infrequently affected but is generally less severe.
- Mild – Mild Tinnitus is often only noticed in the absence of normal background noise and so may be mostly habituated. Sleep is occasionally disrupted but day-to-day activities are usually unimpeded.
- Slight – This level of Tinnitus is the least severe and may only be noticeable on rare occasions. As such, the majority of people suffering slight Tinnitus are untroubled by it and rarely seek corrective help.
Causes of Tinnitus
There are a number of known causes of Tinnitus including:
- Hearing Loss – Electrical signals which are generated by the Cochlea when sound waves enter the ear are processed by the brain as sound. If the delicate hairs or neuronal structures responsible for generating these tiny electrical signals are damaged in any way, for example by exposure to very loud sounds or the act of ageing, then these damaged cells may send continuous streams of electrical signals which the brain interprets as a sound.
- Ear infections and Ear Canal blockages – If the ear fills up with fluid from an infection, or ear wax builds-up sufficiently, then the resultant increased pressure can lead to the cochlea sending electrical signals which are, again, interpreted as sound.
- Head and /or neck injuries – The hearing system is a sophisticated collection of organs and nerves which although protected reasonably well by the skull, are also sensitive to mechanical trauma such as might be experienced following a car crash for example.
- Medication – There are some medications that are known to cause or exacerbate Tinnitus such as some Anti-depressants, Anti-biotics and Malaria treatments. Tinnitus symptoms may cease once these medications are no longer being taken.
- General ill health – There are a wide range of other medical problems that might give rise to Tinnitus such as those associated with the circulation and blood pressure, neurological conditions, osteosclerosis of the bones in the middle ear and so on. Where these physiological problems are treatable, any associated Tinnitus may also diminish over time.
The vast majority of people suffering from Tinnitus will be those suffering hearing loss as a result of sound exposure and the ageing process.
Tinnitus Risk Factors
There are a certain number or well-established risk factors known to be associated with Tinnitus including:
- Exposure to loud noises – loud machinery in factories (especially if hearing protection was not available or being used), rock concerts, personal music players turned up too high as well as gun shots (for example military personnel). NOTE I, the author Paul Lee, spent the early 1980’s working in polymer engineering factories where the risks from noise exposure where not identified and suffer, as a result, from Tinnitus myself.
- Age – The older you are, the higher the risk of developing Tinnitus as the delicate hearing mechanisms become ‘worn-out’.
- Sex – Males are more susceptible to Tinnitus than females.
- Smoking and Drinking – Both tobacco and alcohol use are linked to an increased risk of Tinnitus.
- Health Conditions – Obesity, cardio-vascular problems, high blood pressure and arthritis are all linked to Tinnitus.
Tinnitus Habituation and Sensory Adaptation
A study of the way that our sensory systems work shows that in most cases, sensory stimuli (both internal and external – ‘proximal’ and ‘distal’) is often only ‘processed’ when they are non-linear. What this means is that we tend to process or ‘pay attention’ to those sensory signals which are variable or changing rather than those that are ‘constant’.
For example, if you place a clothes peg on your finger, you immediately notice the pressure exerted by the peg as the pressure sensitive structures in your fingers send electrical signals to your brain which are experienced as ‘pressure’ (or pain depending on how strong the spring on the peg is).
However, if you leave the peg in place and go on about your normal daily routine or activities, your brain will stop processing the signal as the feeling of pressure because the pressure being exerted by the peg is constant and unchanging. This is known as sensory adaptation and is the reason you do not constantly feel the gravitational forces that you are experiencing on a minute-by-minute basis.
However, it is possible to ‘side-step’ this adaptation by re-focusing your attention onto the stimulus thereby allowing you to ‘feel’ the pressure in a more ‘focused’ way.
In some ways, the ringing sounds associated with Tinnitus are also subject to this sensory adaptation inasmuch as some sufferers find that when their attention is focused elsewhere other than the ringing sounds, that the sounds fade into the background and are not consciously ‘noticed’. This is also known as ‘habituation’.
Unfortunately, many sufferers of Tinnitus find themselves allocating lots of attention to the ringing which can lead to the sounds becoming more prevalent or ‘consuming’.
Counter-productive Avoidance Strategies in Tinnitus
Another problem that Tinnitus sufferers often fall ‘foul’ of is the adoption of ‘avoidance’ or ‘safety behaviours’ that are designed to mitigate the ringing sounds, but in many cases have the reverse effect and either magnify them or cause more attention to be diverted towards them.
For example, our natural instinct to loud noises is to cover our ears so as to reduce the volume or intensity of the sounds. This makes plenty of sense when the sound originates from outside of the body, but the sounds associated with Tinnitus originate from within the body and so blocking-out external sounds only serves to reduce the attention dedicated to external stimuli allowing the person to focus MORE on the internal ringing!
So, in this sense, avoiding noise may result in hearing the Tinnitus sounds more clearly and with more focused attention – the opposite of what was wanted.
Habituation and sensory adaptation of the Tinnitus sounds is much more likely to occur if efforts to minimise noise in the environment is stopped altogether.
Cognitive Behavioural Therapy for Tinnitus
CBT is an evidence-based, clinically proven approach to managing emotional experiences through the management of cognition (or thinking processes).
Whilst CBT cannot stop the ringing sounds associated with Tinnitus (because they are generated by physical processes within the ear) it can be particularly helpful for managing the symptoms of Anxiety and Depression that are often experienced as a result of suffering from Tinnitus.
CBT is also useful for helping to expose the counter-productive nature of avoidance and safety behaviours as well as in mitigating and ameliorating any unhelpful thinking styles, core values and belief systems that render the sufferer more prone to feelings of helplessness in relation to their Tinnitus symptomology.
At Tranceform Psychology we have developed a structured, 10 session course of advanced CBT that is designed to help people develop a greater sense of self-efficacy for coping and living with the secondary symptoms of Tinnitus including feelings of anxiety or depression resulting from this chronic condition.
This ‘psycho-educational’ programme can be taken as an e-learning course online without the need for any direct therapist interaction or it can also be taken with regular weekly interactions with a psychotherapist over 10 weeks with a one hour session once per week (via Zoom or at the Wombourne Clinic in the West Midlands).
Teach Yourself CBT and Overcome Your Problems for only £149!
Our online CBT course has been designed to teach you the fundamental tools and techniques of clinically proven Cognitive Behavioural Therapy without having to see a therapist.
Structured over TEN, in-depth modules, this self-managed course will teach you everything you need to know to change the way you think about and experience your mental health problems without having to visit a therapist.
Click Self-Help CBT to find out more.
Free Initial Consultations for Tinnitus
We offer all prospective clients an initial consultation to discuss your Tinnitus prior to commencing any treatment plans.
The consultation is free and lasts around 50 minutes.
During this consultation we will discuss the various options that are available to you and make a considered recommendation based on your individual personal circumstances.
Initial consultations are also available as part of our online therapy service.
At Tranceform Psychology we recognise the importance of the therapeutic relationship in helping people to bring about effective change, so its important to be able to ‘meet’ to discuss our change programmes BEFORE proceeding.
Our policy is to help people make a fully balanced & considered decision about undertaking work with us, including both the financial and personal implications.
Overcome Your Mental Health difficulties with Our Online CBT Programme - From Only £299!
Cognitive Behavioural Therapy is clinically proven to be effective for a range of mental health problems and can be carried out in the comfort of your own home.
Structured over TEN, in-depth modules, our advanced CBT course will teach you everything you need to know to change the way you think about and experience your problems without having to spend a fortune.
The course is available with 2, 5 or 10 sessions of clinical support in-clinic or using Zoom.
Click Tranceformental CBT to find out more.
Also available as a self-directed course that you manage yourself without interacting with a therapist for only £149.