What’s that ringing in your ears? - Marc Fagelson
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Tinnitus may be a confusing event – hearing an unidentifiable and unfindable sound that is for some people as real as it is unreal. The perception of this sound, as the perception of any sound, can affect a person’s emotions, state of arousal, sense of well-being. Tinnitus mechanisms and effects are summarized clearly here. When a person’s tinnitus is perceived as demanding attention, it appears to do so in the same way as other important sounds; tinnitus activates neural centers associated with arousal and, in some cases, survival. For example, imagine the potentially diverse responses to hearing the sound of a mosquito. To many people, the sound is irrelevant, not even a minor irritant because they are among those fortunate individuals whom mosquitoes tend to ignore. Their experience ensures the mosquito demands minimal attention in much the same way as, say, a fan or distant traffic noise. Now consider the mosquito sound for a person who is routinely bitten. This person’s response will be different; at the first sound of the buzzing, the person reaches for repellant, or begins waving hands furiously. Again, the person’s experience and knowledge of the sensation dictates the arousal and reaction linked to the sound. A more vigorous response might be experienced by a pregnant woman in the tropics who associates the mosquito sound with the transmission of Zika, and the existential threat to her unborn child. All three people hear the same sound, but their emotions and sense of dread are dictated by the ways in which their experience and circumstance influence their evaluation of the mosquito sound. No wonder tinnitus can be so bothersome to some patients, particularly when associated with a traumatic event. This article provides an existential psychologist’s perspective on psychological management of bothersome tinnitus.
Tinnitus is one of the most prevalent health conditions in the world. Among US military veterans tinnitus is the single most-often compensated medical condition. Statistics regarding tinnitus prevalence in different patient groups reveal that tinnitus affects people with little regard to ethnicity, gender, or age. Tinnitus often accompanies loss of hearing; when it does, the management of hearing loss with hearing aids or surgery has the potential to reduce tinnitus severity. The rule of thumb among clinicians is to manage hearing loss first, if possible. And notice that we refer to “tinnitus management” rather than “treatment.” For many people, “treatment” implies “cure,” which cannot be promised to most patients. Therefore, tinnitus interventions target coping and management rather than promoting the cessation of the sound itself. Psychological interventions, in particular cognitive behavioral therapy (CBT) offer at this time the strongest evidence base This article summarizes interventions and their objectives, while this article offers evidence supporting the use of CBT (note also that this same author, Rilana Cima, has a CBT chapter in the aforementioned book). Several support groups and associations are devoted to dispensing accurate information in reasonable ways to the public. The American Tinnitus Association (ATA.org), British Tinnitus Association and the Ida Institute offer excellent materials for patients and providers. The Tinnitus Research Initiative also provides updates regarding ongoing and emerging research.
Tinnitus in Culture and Society
Several movies and recordings reference elements of the tinnitus experience. Many of these instances are mentioned in a chapter from this book. An increasingly loud tinnitus tone often accompanies exposure to extreme sound levels (as at the end of Saving Private Ryan as Tom Hanks perishes on the bridge) or an impending loss of consciousness related to stress or disease (as in a few place during Dallas Buyers Club). Tinnitus references in literature and music are numerous and several are reported in detail here. The intrusiveness and persistence of tinnitus can modulate over time for many patients depending on external noise or other attentional targets. This situation appears in a song that captures, to a first approximation, the tinnitus experience shared by millions of people. In it, a tinnitus-like sound fades in and out of the recording so that, even though the chords and lyrics are clearly audible, so is a recurring high-pitched piercing sound. The recorded “tinnitus” sound is labile, potentially annoying, yet it is maskable and at the end of the day, the sound manifests as something to be heard and interpreted. Non-Alignment Pact by Pere Ubu from 1975, in my opinion, takes the grammy in the “Song Most Evocative of Tinnitus” category, and serves as a reminder that the goal of the patient is to accept that tinnitus may now be a “part of the song” so to speak, as they navigate the world of sound that surrounds them.
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