Living with Tinnitus

Tinnitus is a condition where one experiences permanent “ringing in the ears.” You may have experienced temporary ringing after a concert or particularly loud event, but for those of us with tinnitus the ringing does not fade away or disappear in the morning. There are no pills or medical procedures that will remove the condition — it is a permanent state that requires a reframing of one’s life to adapt to. After more than twenty years of living with tinnitus and learning to navigate its daily ups and downs I have developed some strategies that I find helpful. I wrote this note in case these ideas can help others (and to remind myself during more difficult episodes).

At onset, realizing the ringing is not going away is disorienting. Unsettling thoughts reign, as “fight or flight” dominates the experience; irrational and unreasonable fears will likely present themselves. It is important to understand, as early as possible, that you can and will develop strategies that provide meaningful relief, regardless of how loud or distressing the ringing appears. The truth is there is no actual source producing vibrations in your ear, but irreparable damage inside the ear is causing signals to the brain that are experienced as sound. This fact, combined with the brain’s ability to adapt and form new neural connections in response to environmental changes, opens a door to relief by retraining your brain in how you react and how you respond to the spurious sound.

A useful framework, due to sound engineer and tinnitus patient Mike Petroff, is captured by the acronym RIGHT: Relax, IGnore, be Happy, and give it Time. 

The first order of business when the ringing commands your attention is to try to Relax. You are ok. The ringing is not a symptom. It is distressing, for sure, but breathe. You will be ok. Try to relax in the moment and not let the extra brain signals derail your activity. As best you can, you need to IGnore the perceived sound. Turn your attention to something else. Start a new task, go for a walk, put on some music, organize your desk — do anything to take your mind in a different direction and help you ignore the ringing. It may not work immediately but keep at it. Eventually, there will be gaps of time where you are not bothered by the ringing. Next, try to be Happy. Yes, the ringing is awful and won’t go away, but you still deserve to have good experiences in life, positive thoughts, and the full range of human emotions. Do something that makes you happy and it will help you relax and ignore the annoying persistent brain signals. 

Finally, and this is the most important, give it Time. Whatever you are feeling now, it will change; some days are diamonds, some days are stone. It may feel like an unbearable weight today, but there will be future times where it will feel manageable and where you will be unbothered by the signals. These better times can become increasingly common with focused training of your reactions. The onset is like a shipwreck with waves tossing you about, but over time with concentrated effort to reframe your reactions you can increase the spacing between the heavy anxiety waves that stem from the disability. The “RIGHT” approach can help you experience more time being free to focus on normal things and not on your frustrating and debilitating condition. 

The only real constant is change. Perhaps after a few weeks of relative peace with your tinnitus there is an unexpected change and everything “sounds” worse, maybe much worse. Such changes can be distressing, but this new “setting” is not permanent, it too will change. Continue to retrain your reactions away from letting the biological signals annoy you. You are alive. The ringing affirms this. Whatever the change, we have the power to reframe how we experience it by retraining our brain to how we react. The signals will not “go away” or “disappear,” so reject thoughts that lead down that path and instead work to take the mind away from focusing on the sound and onto more constructive thoughts that relegate the ringing to a lower level of our lived experience. We must make peace with the brain signals as an ever-changing constant part of life. 

Many people find relief through “masking” which is adding an external source of sound to the environment to hide the ringing. In a typical home or work setting there is often enough ambient noise to mask the tinnitus. But there will also be daily moments that are quiet enough to reveal the ringing, such as waking up, going to bed, sitting in a quiet office trying to read, standing in a quiet kitchen, and so on. The noise from a radio or fan can mask the ringing and provide comfort by letting the brain focus on the external sound while we go about our activities. There are also online audio sources with different levels of white noise that can help. Masking can certainly provide effective relief, but it is also important to continue training the brain’s response.

In my case, the ringing is present in both ears but louder in the left ear. For this reason, I would usually try to fall asleep on my right ear and let the masking audio take over the left ear. Several years ago I decided to fight against this and “lean in” to the sound by forcing myself to fall asleep with my left ear in the pillow. This made the internal perception of ringing as loud as it could be, but it also made me focus on retraining my reactions. With the sound so present I needed to actively think above the signals and understand it not as actual sound but something to train my brain to accept. Over time I got better at pushing the ringing to a lower level of thought which allowed my internal dialogue to work above the sound. This process was not easy, but my reaction is now more often neutral than distress, which allows me to engage in typical thoughts while falling asleep instead of focusing on the ringing and how it was preventing me from sleep. If I wake up in the middle of the night I don’t have to re-introduce masking sounds, I can think through my process to try to relegate the ringing to a lower psychological level. It usually works, but some days are diamond and some days are stone.

Time is important. After an airplane ride or exposure to a loud event you may notice a change in the ringing. Usually this is a transient change and things “settle down” to what you were used to after a few days, but sometimes it’s not and things seem noticeably different. These times are the most distressing. It takes active focus and concentration to relax, give it time, and work on retraining the brain to rise above the change. Sometimes this doesn’t work and I will have long periods with less sleep and much frustration. But we must forge on with continued determination to accept this new order and move above and beyond it, and get back to the business of living. These longer-term adjustments happen a few times a year for me, often after a specific loud event or some experience that you weren’t prepared for it to be as loud as it was (like an unfamiliar subway ride). In all cases I have found time the most important ally. I have to remind myself how I feel today will change and how I experience the sounds will change. Give it a few weeks and reassess. I have the power to make it better by working on retraining my brain to accept and adjust to the new setting. 

Given the loudness of modern movies and concerts, I recommend musician plugs which are ear plugs molded to your ears that have attenuators to lower the volume without cutting the quality of sound like standard foam ear plugs do. I have 9 and 25 decibel attenuators (9 is good for movies, 25 for louder situations) made by Westone (plugs and audiologist visit for molds cost about $200 total).  I find weather, food, and stress also affect the ringing. Accepting the ebb and flow of life with tinnitus has freed me from worrying about how everything I eat or drink affects the perceived sound. Sure, maybe less coffee would make it marginally better at times, but I enjoy coffee. I can enjoy coffee and not worry about some momentary changes to the ringing. I would rather live my life and learn to deal with the ups and downs of perceived sounds than overly focus on keeping the sound away. The “sound” is here for life and I’m better off learning to accept it and not worry so much if it’s louder today or now. That also goes for when the ringing is all of a sudden much quieter – don’t get your hopes up or you’ll be disappointed. 

I write all this now from a place of relative success learning to manage my tinnitus. The ringing is always there and louder than I would like or could imagine, but the percentage of time where it really bothers me has decreased. It remains a daily frustration but I’ve learned to accept this as a normal part of living with tinnitus. Many people have disabilities and life-long health issues that they must learn to live with. Everyone has their struggles and just because someone looks “normal” doesn’t mean they are not dealing with significantly challenging health issues or other personal matters. We must do our best to slow judgement and afford as much grace and support as we can offer. 

It can be frustrating to have an invisible disability, but the good news is you can retrain the brain to reframe the ringing and change your reaction to acceptance. Before you know it you will have given it many years of time and be better able to contextualize and accept this annoying condition as a part of your life. Each year gets a little easier to accept and lean on past years with increasingly more good days than bad days. I hope these thoughts help you and that over time you will have more diamonds than stones.