How do I stop this noise in my ears? I’m told nothing can be done about tinnitus!
Are you aware recent studies show up to 70% of people experiencing tinnitus experience significant improvements in their tinnitus with the right help?
There has been decades of studies in fields of Audiology, Neuroscience and Neuropsychology into what causes Tinnitus and therefore how to treat it.
I have been inspired in the last decade by work in Neuropsychology and the Brain Sciences. My views about tinnitus have changed over my 38 years working in the area.
I no longer think of someone with tinnitus with thoughts of pity and horror. It amazes me how if you mention tinnitus you hear pity. I’m not callous or don’t appreciate the impact it is having on person with tinnitus lives. I’ve just seen too many people successfully gain control of their lives even though they experience Tinnitus.
“Now I get excited at the possibilities for this person to improve the quality of their life.“
Of course, we have no cure for tinnitus.
However, it is possible to take control of your Tinnitus and improve the quality of your life.
There are multiple studies showing it’s possible to develop the ability to ignore, or adapt to your tinnitus. This alone can be the difference between tinnitus being intolerable to being a minor annoyance.
I’ve just told YOU it’s possible to adapt or even ignore your tinnitus. How is that possible. I’ll say it again. Brain science and Neuropsychology shows the way!
Let’s take a look at what parts of the brain are involved with tinnitus. This diagram shows the different parts of the auditory (hearing) system.
You may have heard of the limbic system. The thalamus, hippocampus, amygdala and cingulate gyrus are part to this system.
Your reaction to tinnitus comes from your emotional processing system, the limbic network. It does not act alone.
It interacts with other large scale neural networks that look at how we process sound, pay attention and other cognitive processes.
It was in Sept 2016, that Fatima Husain published a research study “Tinnitus and Its Relationship to Emotion, Exercise”. It showed how the interaction between all these networks in the brain explains the concentration, attention and sleep issues reported by those with tinnitus.
She also compared a group with mild tinnitus with those with bothersome tinnitus and found those with mild tinnitus engaged the middle frontal cortex (green) more. However, those with severe tinnitus activated the amygdala and parahippocampus (yellow) when hearing sounds with emotional meaning.
The conclusion from this study was the frontal cortex plays an important role in getting you used to sound ie habituating your tinnitus. Note – The frontal cortex is where our attention mechanism lies.
Ms Husain founds those who have higher physical activity levels also have lower tinnitus distress.
In her 2015 review of 20 years of functional MRI studies on tinnitus, that she proposed a possible model of habituation to tinnitus. Her model explains how it is possible to use the attention system (via the frontal cortex) to suppress the response from the amygdala and uses alternate nodes of the limbic system like the insula and the parahippocampal gyrus to work with emotion.
The amygdala are 2 almond size nuclei within your brain. They are the first part of the brain to react to strong emotional events.
Its role is to protect you from harm by interpreting hints of danger to trigger automatic ie instant responses. It also activates your sympathetic nervous system It’s the reason when you wake in the morning and pay attention to your tinnitus it seems to trouble you the whole day.
The good news is the amygdala is somewhat open to reason. It’s been found we can use the power of our frontal cortex to modify its response. This is worth noting.
Diagram 1: Neurophysiological Model of the Auditory System from Nature Reviews 2016 -Guideline for how the different parts of the auditory system interact in our brains.
Blue represents our Auditory Pathway as we know it. Sound is detected by the cochlear converted into a signal which travels through the cochlear nucleus, the inferior colliculus, thalamus to the primary cortex. The cochlear through to the inferior colliculus is where we detect sound and it is only at the primary auditory cortex that we and create meaning of the sounds.
Pink represents the part of auditory system which receives somatosensory (touch, feel, balance etc) information.
Orange pathway is our hippocampus and the amygdala. This area of the auditory system is associated with memory and primary emotions. This part of the auditory system is where we emotionally process what we hear.
Green represents the area of the brain involved in attention, focus and control of our thoughts i.e. our consciousness. This area helps us control many parts of our brain – the frontal cortex.
The frontal cortex plays an important role in habituation of tinnitus.
The frontal cortex is also where our attention mechanism lies.
All tinnitus treatments today rely on Neuroplasticity. This is the brain’s ability to reorganise itself by forming new neural connections.
Neuropsychology uses these 3 statements to help us understand how neuroplasticity works :
Psychologist Rick Hanson says “this can mean is that with proper practice, we can increasingly trick our neural machinery to cultivate more positive states.” Because as the Canadian scientist Donald Hebb goes “Neurons that fire together, wire together.”
In January this year, a study was published by JAMA Otolaryngolgy Head & Neck Surgery, where researchers which reported how a cognitive training program focused on auditory skills improved the perception of tinnitus, memory, attention and concentration of those with tinnitus. MRI imaging studies showed strengthening of areas of the frontal cortex, the area of the brain associated with control and attention.
Kallogieri D, Picirillo JF, Spitznagel E (2017) Cognitive training for adults with bothersome tinnitus. A randomised clinical trial. JAMA-Otol Head Neck Surg doi:10.1001/jamaoto.2017.3779
The University of Auckland Audiology department has done extensive research in recent years on the role of attention, brain retraining and sound therapy for those with tinnitus.
It’s like all the years of research in the fields of audiology, neuroscience and psychology have come together and given us new options for treatment. The best part is prospect of helping not just those with mild to moderate tinnitus but those with severe tinnitus. These new treatment options are building on what we already know and understand.
I am excited about the future and what might be possible. One of the key changes in our thinking is the role of attention. The frontal cortex holds possibilities to help gain control of tinnitus.
We can use the principles of brain retraining in the area of attention as a new way to reduce the impact of tinnitus. A core method of improving your tinnitus is to train your attention, concentration and memory. There are multiple ways to do this. University of Auckland tinnitus clinic has researched and developed a program, Brain HQ was the program used in the study just released last month January 2017. Neuropsychology has many attention training options that focus on improving your well being.
How do you practice “Paying Attention”. Neuropsychologist Rick Hanson has written many useful articles on this topic. What is interesting is that attention training is considered an important part of improving your well being. He says “ Whatever you pay attention to has a special power to change your brain. Attention is like a combination of spotlight and vacuum cleaner : It shines light on what it rests on and then sucks it into your brain and your self. “
It is by controlling your attention, you become more able to place it where you want it and keep it there. And most importantly able to pull it away from what bothers or pointless, looping again and again through anxious preoccupations. Rick Hanson describes attention training as the foundation to make your life better.
It’s easier said than done to gain better control of your attention. We need to overcome some challenges. All it takes is one upsetting experience to train the brain to be vigilant with our attention skittering from one thing to another. We are used to significant external stimuli so simple activities like the sensation of breathing feel boring or frustrating.
By just gently implementing these 5 ideas, it will be easier for your brain to use the available attention and brain training programs available.
Remember everyone is an individual and what works for one may not be an answer for you. That is where working with an audiologist specialising in this area is important.
I have started recommending using programs like Brain HQ or attention training methods of Rick Hanson for my clients. I still believe that sound enrichment/therapy whether it’s with nature sounds or hearing aids are an important part of the treatment program. That is another article.
Remember Life is too short to suffer!
Let’s keep talking about how we can take control of our tinnitus?
It would be nice to hear more “I haven’t noticed, that I am no longer noticing my tinnitus.” It’s not an instant option. But it is very achievable.
Should you be worried about your reaction to your internal sounds “tinnitus” or know someone who suffers from tinnitus, we encourage you to see advice from an independent qualified audiologist to discuss your concerns.
Hearing Care Professionals offers one on one consultations either in person or online. Nolene Nielson has been passionate about helping those with tinnitus for over 30 years.
Nolene Nielson is a highly qualified and experienced Australian Audiologist. She has over three decades of clinical experience in many aspects of Audiology, but specialises in the area of hearing rehabilitation for those with hearing loss, tinnitus, hyperacusis and misophonia.
She is passionate about working with those experiencing tinnitus issues. For over 35 years now it has been her consuming passion. Using the principles of audiology, neurosciences, neuropsychology and solution based psychological approaches, she uses the latest practical clinical treatments to work with her clients to achieve the best results possible.