Tinnitus and The Science Behind Change

We have learned from neuroscience that the mind is changeable or “plastic,” meaning the actual structure of the brain can change with experience. A mindfulness practice is a way of influencing this change and positively creating new wiring in the brain circuitry.

For the person experiencing bothersome tinnitus, this is certainly good news. According to the American Journal of Medicine, about 16 million people were bothered enough by chronic tinnitus in the past year to report tinnitus to their doctors. Some 1 to 2 million people live with tinnitus that is severe enough to interfere with their abilities to function in daily life.

Using mindful awareness, we can shine a light on the mind’s inaccurate, habitual reaction to tinnitus signals and see it for what it really is: a sensation that does not need to be monitored by the mind, poses no credible threat to survival, and, therefore, can safely fade from our conscious awareness. 

Compelling studies support the argument that mindfulness can lead to more adaptive changes in a patient’s response to old and new stimuli.

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Tinnitus: Changing Perception

Mindfulness is a way of approaching each moment by focusing one’s attention and purposefully living in the moment as a way of relieving physical and emotional pain. This is not a new idea. Rather, mindfulness is a 2,500 year-old practice that is experiencing a resurgence, in part because of recent scientific findings that substantiate its myriad healing benefits.

EarPuzzleA growing body of research has shown the efficacy of mindfulness-based approaches in managing chronic pain, sleep disturbances, depression, anxiety, multiple sclerosis, cancer, and long list of other health maladies. My own research suggests that mindfulness can also be particularly useful in managing tinnitus.

I first learned about mindfulness as a pain management tool when I was a clinical psychologist and researcher at the University of California, San Francisco. After seeing the positive impact it had with other conditions, I wanted to study the impact of mindfulness therapy in changing a person’s relationship with bothersome tinnitus. With several colleagues, I organized a pilot study in which eight tinnitus patients received eight weeks of Mindfulness Based Tinnitus Street Reduction (MBTSR).

The results of this study were stunning. We found that mindfulness therapy greatly reduces the perceived burden and handicap of tinnitus. What’s more, the benefits were enduring, with improvement lasting through the end of the 12-month study window. In addition to a decrease in tinnitus burden, depression and anxiety scores went down and quality of life scores went up after program completion.

images-3So what is mindfulness and how does it improve a person’s perception of tinnitus? Mindfulness is a way of approaching each and every moment that arises with a “special” kind of awareness. By “special” I mean not just an ordinary awareness but rather full consciousness of immediate experience, approached with curiosity, acceptance, openness to whatever arises, and a gentle self-compassion toward one’s self.

Tinnitus patients often try to avoid awareness as a way to ignore the ringing in their ears. This works for some, but it also closes people off from living a full, unencumbered life. Mindfulness teaches that we can benefit by fully embracing our experience with tinnitus. By leaning into our tinnitus, we can break through to a better, fuller experience. Mindfulness also helps relieve the anger and apathy that so many tinnitus patients experience.

A Recap of the 8th International Tinnitus Research Initiative Conference (TRI)

I recently attended the 8th International Tinnitus Research Initiative (TRI) Conference, March 10th through the 13th in Auckland, New Zealand. Every year the Conference brings together researchers, otologists, neurologists, audiologists, psychologists, and an array of hearing health professionals to report on their findings in the field of tinnitus.

jennzIt was amazing to have various disciplines from around the world coming together to share their work. Tinnitus research is being done all over the world, and the sharing of ideas is crucial to steady growth. I gave a workshop on the first day on my findings and experience creating Mindfulness Based Tinnitus Stress Reduction (MBTSR) and our online course, MindfulTinnitusRelief.com. There was great interest at the meeting in mindfulness as a management tool for tinnitus—and interest in the online version of the 8-week course, making mindfulness training easily available to people all over the world. 

The first day of the Conference consisted of workshops by leaders in the field, including: Dr. Grant Searchfield of New Zealand, presenting on sound therapies; Dr. Natan Bauman of the United States, presenting on Cognitive Habituation Tinnitus Therapy (CHaTT); and Professor Billy Martin from Singapore, presenting on building a tinnitus practice from the ground up, describing his experience setting up a new tinnitus clinic in Singapore.

The days following were filled with presentations covering a broad range of topics from transcranial stimulation, evidenced based treatments, sound therapy, brain imaging research, hyperacusis, and multi-sensory contributions to tinnitus and others. 

jennz2It is encouraging to see how different disciplines are coming to similar conclusions in their results. Josef Rauschecker, PhD from Georgetown University shared his findings implicating a decrease in cortical brain mass in people with tinnitus in the very same areas that mindfulness brain-imaging research is finding increased growth (specifically: Medial PreFrontal Cortex and right insula). This is very exciting to see, and a study combining neuro-imaging with the 8-week MBTSR program is a research direction to be explored. 

I left the TRI Conference very excited and inspired to share MBTSR with people around the world. This year I will be collecting data to present at next year’s Conference on findings of the efficacy of the MindfulTinnitusRelief.com online course for tinnitus relief.

What is Tinnitus?

Interest in tinnitus and its treatment has grown in recent years, largely due to increasing awareness that tinnitus is the most common service-connected disability for veterans returning from recent military service in Iraq and Afghanistan (Department of Veterans Affairs, 2010). Tinnitus is a medical term for acoustical perceptions heard in the ear(s) or head, but not produced by external sound. EarPuzzleThis sound, which is often described as a ringing, buzzing, pulsing, whistling, or humming, can be experienced in one or both ears with varying intensity, loudness, and pitch. Approximately 50 million people in the United States experience tinnitus at some point in their lives. Around 16 million of these Americans experience tinnitus bothersome enough to consult their doctor. Two to three million are so severely affected by their tinnitus that their ability to function is severely impaired.

Tinnitus is a symptom rather than a disease and may develop from exposure to loud noise; a head injury; aging, outer, inner, or middle ear problems; neck or jaw disorders; cardiovascular disease; or use of prescription or non-prescription drugs. While many theories have been proposed to explain the occurrence of tinnitus, it is a multimodal disorder that may have different causes and different pathophysiologies. This makes tinnitus difficult to treat; oftentimes, interventions meet with only variable success. 

closeupTinnitus can have a major impact on a person’s life. Severe tinnitus is most commonly associated with anxiety, distress, sleep disturbance, and depression. Disrupted sleep is the most significant complaint, affecting as many as 70% of tinnitus patients. Studies report a lifetime prevalence of 62% for major depression, with 48% of people with tinnitus displaying current depression, and 45% reporting an anxiety disorder. Poor attention and concentration, interference with work, and negative impact on personal relationships are commonly reported by patients. Almost all patients indicate that stress or tension makes their tinnitus worse.

How Do You Get Tinnitus?

Tinnitus is not a “disease” but is rather a “symptom” of some other change in the body. Examples of such changes in the body that may cause the symptom of tinnitus are loss of hearing related to the normal aging process, an injury to the ear, or a circulatory system ailment.

coveringOther causes of tinnitus may be from exposure to loud noise; a head injury; outer, inner, or middle ear problems; neck or jaw disorders; cardiovascular disease; or use of prescription or non-prescription drugs. It has been estimated that as many as 40% of people with tinnitus can’t narrow down a specific cause or incident leading to tinnitus.

While many theories have been proposed to explain the occurrence of tinnitus, it is a multimodal disorder that may have different causes and different pathophysiologies. This makes tinnitus difficult to treat, and oftentimes interventions meet with only variable success. Three common causes of tinnitus are:

Noise Exposure

Ear and sound wavesNoise exposure is one of the most common causes of tinnitus. In fact, tinnitus is the number one medical complaint of Veterans returning from recent wars due to loud blasts and gunfire. Listening to loud music for prolonged periods of time can also damage the ear resulting in hearing loss and tinnitus. The best way to protect your ears is, of course, to avoid loud noise. But if you must be in a noisy environmentsuch as a music concert or loud factory—start protecting your ears NOW. Wearing ear plugs when you are in a very noisy environment is one great way to protect your ears from further damage. Ear plugs can easily and inexpensively be purchased at a local pharmacy, or you can have them custom made by a hearing health professional.

Aging

Aging is a beautiful, inevitable part of life. And with aging comes a certain amount of wear and tear on the body. For this reason, hearing loss due to advancing age is quite common. The medical term for age-related hearing loss is presbicusis. Not all people with presbicusis develop tinnitus but quite a few do. Again, there is no use in fighting the aging process so being good to your ears from this moment forward is best.

Prescription or Non-Prescription Drugs

The side effect of certain drugs can cause or worsen chronic tinnitus in some patients. Tinnitus triggers include: various antibiotics, pain killers, anti-anxiety and anti-depression drugs, diuretics, anti-malarial medications, anti-cancer drugs and blood pressure controlling medications. It is important to ask your doctor about medications that may harm your hearing. Use these drugs only if the benefits outweigh the risks.