Tinnitus: The Ringing in the Ears That Grows Louder the More You Listen

Half past eleven at night. The house is completely quiet. Ek turns off the light to sleep, and there it is again.

That high, thin ringing in his ears — barely noticeable during the day, but as soon as everything around him falls silent, it rises until it is maddening. He tries to ignore it, and the harder he tries, the more prominent it becomes, as though someone were slowly turning up a volume knob inside his head.

Ek has begun to dread going to bed. The night before, he picked up his phone at three in the morning to search for what this was, and the more he read the worse he felt, because he found only frightening things. He did not sleep at all, and by morning he was too drained to work.

What makes Ek feel most alone is that nobody else can hear this sound. When he tries to describe it, he is afraid of being seen as imagining it.

A sound the brain produces is not therefore unreal

Tinnitus is the perception of sound with no external source producing it. It is very common, and in many cases associated with changes in the auditory system — from exposure to loud noise, or from hearing declining with age.

Current understanding holds that this sound mostly does not arise in the ear alone but involves how the brain processes hearing. In some cases, when the auditory signal reaching the brain changes or diminishes, parts of the brain may increase their activity to compensate, producing the perception of a ringing — rather as a nervous system may continue generating a perception even without direct external input. That the sound is produced by the brain therefore does not mean you are imagining it. It is a perception genuinely occurring in the nervous system.

The important first step is finding the cause

Before discussing care for the mind, something important needs emphasizing. Certain presentations of tinnitus should be assessed by an ENT doctor or a hearing specialist — particularly when the sound comes on suddenly, is in one ear only, pulses with the heartbeat, or arrives together with reduced hearing or dizziness — because some cases may signal a condition that is treatable and deserves attention. Assessment is a first step that should not be skipped. The approaches to caring for the mind described below work alongside it, not as an alternative to diagnosis.

Why the quieter it is, and the harder you listen, the louder it grows

Think of the hum of a refrigerator at home. It runs constantly, but ordinarily we do not hear it, because the brain learns to filter out sound that is steady and harmless — until someone mentions it, and suddenly we hear it. And once we focus on it, it seems to grow louder and louder.

Tinnitus engages the brain's filtering and attention mechanisms in a similar way. In the quiet of the night, with no other sound to mask it, the ringing is unusually prominent. And the more attention we give it, the more the brain files it as an important sound requiring monitoring — which makes it more prominent still.

What is interesting is that the loudness of the sound and the distress caused by hearing it are not always the same thing. Two people with ringing at a similar level may differ considerably in how distressed they are, depending on how the brain and the emotions interpret that sound. If it is read as a threat, or as a signal that something is seriously wrong, fear pulls attention back toward it — and it becomes a loop in which the more we fear, the more we hear, and the more we hear, the more we fear.

How to care for it while the sound remains

What we would want understood clearly is that in many cases the aim of care for chronic tinnitus is not to make the sound disappear entirely, which is frequently difficult. It is to reduce the distress it causes, and to help the brain learn to filter it out until it barely intrudes on a life — what is called habituation.

Approaches with reasonably good research support for reducing distress include sound therapy or masking, and for some people with reduced hearing, hearing aids have a part to play. What these approaches share is that most of them do not erase the sound. They work with attention and with the emotional response to it.

This is exactly where hypnotherapy can work, because it addresses the two principal factors determining how much the ringing disturbs us — attention and emotional arousal — in order to support the brain in returning to its natural filtering.

At NBRH we work from the principle of Neuro-Behavioral Repatterning & Hypnotherapy: changing the response patterns of the nervous system and of behavior in a structured way. Living with tinnitus with good quality of life usually does not begin with fighting to eliminate the sound. It begins with changing our relationship with it, until it loses the power it once held over us. That is what lasting change means here.

To understand how amplified perception works in the context of pain, we have written “Chronic Pain, Migraine and Fibromyalgia”. And if you are wondering how anxiety and arousal affect the body and sleep, “Anxiety: Why the Brain Reads Everything as a Threat” fills in that part of the picture.