Tinnitus — always dreaming of silence
What do I have in common with Rick Beato, Van Gogh, and Homer Simpson?
*Please note that there is a free audio podcast read-aloud version of this article available here.
So, what is that Rick Beato, Van Gogh, Homer Simpson, and I (along with many other musicians, songwriters, and audio professionals) all have in common?
Tinnitus. Hearing noise which has no cause or sound-source in the outside world.
A quick disclaimer. I’m a musician not an audiologist. Fact check this article. It’s based on my personal experience. I’m not trying to provide definitive advice. My experience is that everyone is different, and what works for one may not work for another.
What tinnitus is (allegedly).
Apparently everyone gets tinnitus once in a while, so for example a tone or ringing noise in your ears after a very loud concert, or day working with noisy power tools. Usually this ringing or tone (or it could be like white noise, or a waterfall, or cicadas, or the sound of a fast train passing close by) only lasts an hour or two. Unfortunately for some people it either never goes away again, or it consistently comes and goes intermittently on a regular basis (so daily, or weekly). Some sources online state current (they say conservative) estimates of the adult population with permanent tinnitus at between fifteen and twenty percent.
Medical research seems to show that tinnitus is not a sound produced within the ears themselves. It’s a sound generated in some other part of the brain.
There also seems to be a link between tinnitus and reduced blood flow in certain parts of the brain. It’s not yet clear if increased blood flow will reduce the perceived sound tinnitus produces.
The current most popular speculative hypothesis about tinnitus is that the brain creates a sound equivalent to what the ears are desperately trying to hear. The ears are searching for a sound that should be there. Based upon similar past sound experiences there is kind of an emotional expectation that this particular sound should be present. However (due to, for example, hearing loss or damage to some part of the inner ear) the ears cannot hear that particular sound.
Somehow the brain plugs any gaps in the expected spectrum of your hearing, and supplies a replacement for something it believes you are emotionally attached to, want to hear, should hear, but cannot find.
The theory goes that temporary post-concert ear ringing is caused by a temporary overload to, and thus protective shut-down of, the cilia (minute hairs within the inner ear’s cochlea) and stereocilia (hair clusters atop the cilia) which vibrate in unison with particular sound frequencies, thus transmitting sound to the brain. When the cilia and stereocilia have recovered from their concert trauma they reactivate, the ringing stops, and you get your hearing back in that frequency range.
As will be seen tinnitus is not only related to hearing damage. However when it is linked with over exposure to excessive loud noise, what usually happens is that the cilia (and their stereocilia) that respond to the particular frequency of the excessive noise shut down permanently. Their cells do not seem to be able to self-repair (along with, apparently, teeth enamel, retinal cells, brain cells and some parts of the heart ). So effectively they die. When this happens, when cilia are permanently damaged and dead, tinnitus can be the result. Normally it is constant (24/7 — although who really knows if tinnitus is still there when we are sleeping). Having said this there are some people (the exception not the rule) who have recurrent tinnitus episodes from-to-time (Rick Beato being one such, who says he generally experiences several days per week without tinnitus).
The theory continues that the more you focus on that perceived tinnitus sound, the more intensively the brain tries to create it. If, on the other hand, you ignore it, simply pay no attention to it, eventually it will reduce or disappear completely (theoretically).
As yet there is no known medical cure for, or operation to repair permanently damaged cilia (and stereocilia). As will be seen there are some proposed theoretical future ways to repair cilia (and stereocilia) that are currently being researched and developed.
What are the known causes of tinnitus?
Tinnitus is a symptom not a disease.
As far as medical science knows so far, there is no one underlying cause of tinnitus. It can be triggered by one of many, or a combination of multiple causes. For example (and not a definitive list):
Hearing damage — usually caused by exposure to extremely loud noise.
(Age related) hearing loss.
Injury (for example to the ear, face, nose, jaw, neck, skull, or back).
Ear, nose or throat infection.
Wax build-up within the ear.
Blocked eustachian tube.
Stress, in particular extreme tightness of the jaw muscles (known as Bruxism).
A tumour (most often in or near the brain).
Chemotherapy.
Hereditary, genetic, or congenital disorders.
Reaction to aspirin, or other chemicals.
Symptom of another condition, for example Maniere’s disease (of which Van Gogh was a sufferer).
Side-effects — the impact tinnitus can have on one’s life.
The most obvious side-effect is a reduced hearing range — as tinnitus effectively internally masks any real external sounds with similar sound frequencies.
Generally the psychological impact of tinnitus includes: anxiety, depression, insomnia, and exhaustion (tinnitus 24/7 can be totally exhausting).
The impact tinnitus can have can depend upon its severity. Simply put, severe chronic tinnitus can devastate a person’s mental health. They can start to create unhealthy, self-destructive, un-useful patterns / feedback loops in their lives. This can quite literally drive a person crazy, and in some cases to suicide. Stated in its simplest form, these feedback loops can occur when a person focuses upon nothing apart from the sound of the tinnitus in their head… this perseveration is a recipe for disaster. The opposite — ignoring the sound of the tinnitus — is the antidote to this mind poison. It sounds obvious and simple enough, yet it’s easier said than done. Especially in the early days, when chronic tinnitus first starts, and then stays.
My own personal experience of tinnitus.
To get directly to the point most people I know, including some of my closest friends, have no idea I have tinnitus. I simply don’t publicly make a thing of it. Sure they notice that sometimes I don’t hear so well, but they just think I’m old and deaf. Long ago I heard other people with tinnitus talking about ‘my tinnitus’ and describing themselves as a ‘tinnitus sufferer’. I decided that was not for me. So generally I just keep quiet about it. Stiff upper lip and all that.
I first noticed tinnitus (that did not go away after a few hours) during the mid-Eighties, when I was in my mid-twenties.
I still have tinnitus today. It’s never totally gone away. At least, not yet.
Over the years I’ve tried so many things — to reduce it, mask it, cope better with it, or cure it. There has been no totally eliminating silver bullet. Somethings had little or no effect. Somethings helped a bit, and gave me better ways to manage the condition.
In my case what were the possible contributing factors that initially caused the onset if tinnitus?
I think the short answer is that I was, and still am, an audiofile, and if I suffered from anything it was melomania. I used to love listening to music loud, on good speakers. And from when I was sixteen or seventeen I was constantly in and out of recording studios, rehearsal rooms, gigs and nightclubs. So probably the key culprit was hearing damage caused by this cocktail. Not to mention that there is a history of hearing-loss in my family (none were musicians, none were loud-music listeners, none worked in excessively loud environments), and my mother has had tinnitus for years.
However I think in my case there were other possible contributing factors, which all come under the heading of ‘inexperienced lifestyle choices in my early twenties’. For example.
I played rugby, as a forward, and I had several injuries, including a pretty serious neck injury.
I rode very loud motorbikes. On one occasion I was knocked off my Harley Fat Boy by a London double-decker bus. It rammed me from behind when I was doing a left turn. I was indicating and trundling along at about twenty miles per hour. I was catapulted off said-Hog, and landed unconscious on the pavement, with my crash-helmet split open, but my head intact. So this time a whiplash variant of a neck injury.
I had all four of my wisdom teeth removed under general anaesthetic. After that I had problems with my bite and excessive muscle tension in my jaw.
I had to have a mid-Eighties cocaine abuse induced septorhinoplasty, to unblock my chronically blocked and infected sinuses, and correct my rugby induced multiply-broken nose.
When whatever switch in my head was flipped and the tinnitus stayed on permanently, well at first it didn’t bother me. Occasional ringing in the ears was quite a normal occurrence for me, and had been for years. I was in my mid-twenties and I had been working in recording studios for several years by then. Sixty-hour weeks was quite normal. Loud playback was quite normal. In those days there was no warning sign on the studio door, indicating that your hearing could be at risk upon entering. The same went for gigs and nightclubs, which I attended regularly. And the same went for rehearsal rooms, which I also frequented regularly. Nowadays you can’t get on to a soundstage without signing a disclaimer confirming you are aware of the risks, and being offered ear protection.
When I finally realised that the noise in my head was not going to abate, well, the first couple of years was a living hell for me. From time-to-time during the last thirty-five years I had extended periods of time (months, sometimes years) where I found it very difficult to cope. But that first twelve to eighteen months, well it was a game changer.
My tinnitus (there I said it) is constant, chronic, in both ears, quite loud, multi-frequency with white-noise, mainly a high a frequency, somewhere around 5KHz. From time-to-time it can change frequency (usually temporarily) and become intensively loud (usually temporarily). However from time-to-time a new frequency has joined the ranks and stayed. I don’t have any associated pain, some people do.
Like I say, the first year or so was heavy. I tramped from one doctor to another, from one therapy to the next… all the usual culprits. Masking the tinnitus with recordings of waves, or waterfalls, or whale-song, or native-American flute music. I even had a small Walkman size device (I think called a MindLab) which allegedly created beta and theta waves etc, similar to those the brain produces. I had probably every kind of massage known to humankind. I tried chiropractic. I tried acupuncture, qigong, yoga, herbal medicine, and diet changes. I tried dentistry. I became vegetarian. I tried various meditations. I got deeply into philosophy, religion, spirituality, and alternative lifestyles. I met experts who claimed tinnitus was a great gift, and that it was actually the sound of communication coming from the spirit world and / or aliens. I tried hypnosis and the ouija board. I tried floatation tanks and crystals. I even contemplated exorcism, in case I’d been cursed. I tried pharmaceuticals and plant remedies. I tried alcohol. I tried smoking a lot of joints. I tried living in the countryside. I tried changing my girl-friend, more than once. I tried exercise, especially seriously long hikes up hills and through forests, where I probably hugged a few trees, just in case.
Nothing worked.
After two or three years I felt defeated. And just reconciled myself to a life with constant tinnitus. I became quite stoic about it, and just decided to ignore it the best I could. I decided to not to let tinnitus define who I am. For the most part that strategy has worked. Although, like I say from time-to-time I did struggle, for example, when it became painfully obvious to me that I could no longer work professionally as a sound-engineer, and that being in loud recording studios on a daily basis was a thing of the past.
Having said all of this, although I do not focus my attention on the tinnitus (which effectively means I don’t notice it from minute to minute), I do check in on it from time-to-time. Checking in can be voluntary. (Q to self?: ‘Is it still there?’ A: ‘Yep, still there.’) Or involuntary, due to a sudden sharp increase in volume or major change in tone. The latter is infrequent, maybe every few months. The former, depends upon my state of mind. If all is ok in my world, well maybe I check in weekly or biweekly. If things are a bit pear-shaped, then at least once a day.
What I will say is that in my case there definitely seems to be a physiological component. If I rotate my neck, from looking straight ahead to either extreme right or left, the volume of the tinnitus increases, almost doubles. Same goes if I clench my jaw. If I have regular deep sleep, exercise regularly, and have at least one really deep deep-tissue massage a week (so my neck and shoulders are loose, and not tight with stress) the volume of the tinnitus reduces significantly (maybe thirty percent or more).
Also, and this is probably obvious, if I go somewhere during the evening where there is loud music and stay there for an hour or more, the next morning my head is a mess. The tinnitus volume increases significantly for some hours.
Of course, deep down I haven’t totally given up. I still hope that one morning, after a gig, I’ll wake up and finally all the noise has stopped. I still dream of silence.
Finally, and perhaps most significant (but a topic I feel least inclined to open up in depth about here), certain substances have a profound effect (at least for me) on tinnitus. Back in the day real pharmaceutical grade MDMA made the tinnitus disappear completely for a few hours. It’s the same with other psychedelics, at least for a few hours the tinnitus totally stopped. Floaty very focussed but not trippy-chaotic micro-dosing reduced the volume by maybe sixty percent or more. When micro-dosing the background muscle stress in my neck and shoulders also reduced significantly, so there could be a link between this, and the tinnitus volume. For obvious reasons it’s a difficult topic to talk about openly. I’m sure there is something profound in it. I hope clinical research is done around this, as, based upon my own experience, I’m certain it can supply genuine relief for many people.
One last personal observation before I go back to being stoic, with a stiff, very tightly shut, upper lip.
As far as I can see there is no real recognition (so for example in the UK from the government, the NHS, or the DWP etc) that tinnitus has such a huge impact on many peoples’ lives (if you believe the statistics on some professional audiologist websites, they say one in five adults suffer from constant tinnitus). Especially the impact on the lives of people who rely upon their hearing to make a living, so musicians, sound engineers, etc. There are no social security or pension related benefits. A sound engineer or musician cannot take early retirement due to hearing loss or tinnitus. They simply have to regroup, take stock, re-train and re-tool to do something else. If, and I know this an extreme example (however I just want to make the point clear), you lost an arm or leg in a work related incident, you’d get financial compensation and an early pension. Effectively loosing your hearing to tinnitus whilst working in a recording studio during the 1980s, and you get nothing. Your hearing was deemed to be totally your own responsibility, not that of the recording studio or record company that employed you. And that’s being generous, as I don’t think that back then anyone owning a recording studio, or record label ever once contemplated this topic, it simply was not a thing.
I say this because when I was first active as a professional musician / audio engineer in the Eighties in London there was no information given in the work place (so recording studios, rehearsal rooms, sound stages etc) about the dangers to one’s hearing from exposure to loud noise, or that hearing damage could cause tinnitus.
Because of that many many music business professionals now have chronic tinnitus.
Most never tell anyone — who wants a deaf remix engineer who can’t hear 5KHz (just for example)?
It’s more or less a taboo topic within the music industry today, although at least now there is an awareness. As mentioned there are now (or legally should be) warning signs on studio doors, disclaimers to sign, in ear stage monitoring, attenuating custom-moulded ear-plugs, really good hearing aids, and great software for analysing a mix’s waveform and the output of mix monitors etc… but nothing can replace a good set of ears, and the gift of silence.
(A quick aside. I’ve just re-read this section above — My own personal experience of tinnitus. In some strange way I feel compelled to give full disclosure about all the ails that effect me as a musician. In total there are two. Tinnitus and Dupuytren's contracture aka Viking Hand. I was diagnosed with this more than twenty years ago. Again my main management method for this has been stoicism. It’s most noticeable in my right hand, my guitar strumming and picking hand. Especially on my palm just below my ring-finger and pinkie, where there is a quite noticeable nodule. So far, even twenty years on, it’s not so bad. I exercise, stretch and massage my hands a lot, which seems to keep everything in check. I do notice now that my right hand is tighter. And my right fingers are slower, and not so accurate as before. Also I find it a bit more difficult to hold a plectrum. I drop them a lot more than did. And I can’t so easily pick them up from the floor, my finger accuracy and ability to pick small objects has slightly diminished. I’m not sure if that’s all down to Viking Hand, or old age, or both. There, I am purged, all my stoic secretes revealed.)
How to treat and manage tinnitus?
As mentioned right at the beginning of this article there is no long-term cure for tinnitus. There is plenty of ongoing research, but as yet, unfortunately, no revolutionary new cure.
The potential future treatments all focus on reviving the ‘dead’ cilia and stereocilia, thus reversing the damage. They currently fall into three categories.
Stem cell therapy (introducing new cells aimed at rejuvenating ‘dead’ cilia / stereocilia).
Gene therapy (introducing DNA or RNA into ‘dead’ cilia / stereocilia cells with the aim to rejuvenate them).
Molecular therapy — as I understand it this is research into the molecular mechanisms behind resilience to noise induced tinnitus, and possible future drug therapy to reduce susceptibility to chronic tinnitus.
In a sentence, if you are now experiencing tinnitus caused by hearing damage (so not caused by anything else previously mentioned, for example by an adverse reaction to aspirin, or an ear infection etc) probably the most practical and useful common sense advice is to take the stiff upper lip stoic approach. Meaning, learn how to cope with tinnitus. Learn how to manage it. Deal with it by forgetting about it, by not focusing upon it. Don’t perseverate about it. Break what is sometimes called the Jastreboff Cycle. (After Pawel Jastreboff , who co-developed ‘Tinnitus Retraining Therapy’.1)
Stoic stiff upper lip does not mean suffer in silence (absolutely no sick pun intended). There are now plenty of tinnitus clinics that a doctor can recommend you to, or that you can contact directly yourself. Many offer some variation on Jastreboff’s Tinnitus Retraining Therapy, some neurophysiological model aimed at modifying your view about, and relationship with tinnitus. Simply put, no longer perceiving tinnitus as a difficulty or hinderance.
And of course there are many other things you can incorporate into your life that will also help reduce the impact tinnitus can have on you and your day.
Here’s a list (not definitive or prioritised).
Relaxation / mindfulness meditations.
Massage.
Regular exercise.
Healthy diet. (Define that!)
Sleep (lots of it, and early to bed).
Nature (loose yourself in it).
Corrective dentistry (for example, a gum shield to prevent tooth grinding and jaw muscle tension, and correctly repositioning your bite).
Hearing aids — stimulation of the hearing centres can lead to improved hearing. Hearing aids refocus the brain on other sounds, that maybe could not be heard without the hearing aids, thus these new sounds can help to distract the wearer from tinnitus.
Masking — white noise, whale-song, the radio, background music etc.
Gadgets — for example, masking frequency generators, 180 degree phase reduction apps, the MindLab thingy, if it still exists (beta, theta waves etc), however now I’m sure there are apps and YouTube posts that do almost the same.
Pharmaceuticals — for example Lidocaine patches, but please beware of the potential hazardous side-effects.
And last, but by no mean least…
Distraction — not like masking above (so white noise, the radio etc, although these are of course forms of distraction). Here distraction means something like a fast, mindless, fun computer game. Something like Subway Surfers. The key idea here is to use distraction to re-start and refocus the brain’s natural focus filter. The theory goes that the brain thinks that somehow you have a deep emotional interest in, or need to hear the particular sound of your tinnitus, so it enhances it, brings it to the forefront, and lets you focus on it. If you keep sending a message back to your subconscious brain that you’re just not interested in that tinnitus sound, that your computer game is far more interesting, and you’re in control, then eventually the brain will re-start and re-calibrate it’s internal filter, and reduce the level of the tinnitus sound… that’s the theory at least.
Finally to all you musician and audio pros (and I know you don’t need me to say this), take care of your hearing, and cherish the silences. As the fifth Beatle, Sir George Martin’s autobiography title quite rightly states ‘all you need is ears’.
Please note: I have another infotainment channel on Substack, called Unleashed & Unlimited, where I post podcasts, articles and content unrelated to music.🖋🎥🎙
Jastreboff PJ, Hazell JWP. Tinnitus Retraining Therapy: Implementing the Neurophysiological Model. Boston: Cambridge University Press; 2004:276.