Tinnitus distress: When the ringing in your ears just won’t stop

Have you ever heard ringing in your ears or looked around to see what was buzzing just to realise it is in your head? If you had, then you know what tinnitus is.

Experiencing tinnitus is not unusual at all. For example, many people hear ringing in their ears after they have left a very noisy environment, such as a concert. Most of the time, that sort of ringing or buzzing disappears on its own. However, some people experience persistent tinnitus: they hear it when everything is quiet around them, or they might hear it all waking hours.

Persistent tinnitus can come and go, and even the sound of it can change over time. And it is the persistent tinnitus that can cause significant distress and disruption in people’s lives.

What is tinnitus?

Even though we do hear it, tinnitus is not an actual sound as it has no source. It is a perception of sound caused by changes in the central auditory structures, including the auditory cortex. There are several medical conditions and other factors that can be related to Tinnitus, but the exact mechanism of how or what would cause tinnitus is not yet clear. Just to mention a few conditions that may trigger it: hearing loss, Ménière’s disease, vestibular schwannoma (benign brain tumour on hearing and balance nerve), certain medications (drugs that cause hearing loss, some anti-biotics, some anti-depressants, etc.), noise damage and trauma to the ear or head.

So what happens if tinnitus does not go away, but instead it becomes a permanent feature of your headspace? Even with persistent tinnitus, many people get used to the noise and live with tinnitus after the first realisation and some medical investigation and advice. Therefore, if you do have persistent tinnitus, the first step is to see an audiologist to check your ears and hearing, and they can refer you further if necessary.

When tinnitus doesn’t go away

However, once all medical investigation is done, and you still find your tinnitus hard to bear, there is not much that can be done medically, and for some people, the advice “just live with it “ rings hollow. How can you put up with a jet engine roaring in your ears every night?

When you are unable to habituate to tinnitus (effectively ignore the sound in your ear), it can cause significant distress: constant annoyance and frustration, after all, tinnitus is a chronic condition that cannot be cured. In the long term, this could lead to anxiety and depression, affecting the quality of life and making you feel like there is no hope.

How CBT can help with tinnitus distress

This is the point where talking therapies, specifically CBT, can be useful. While nothing can change the fact that tinnitus has no cure yet, the process of acceptance and habituation can be facilitated.

Cognitive Behavioural Therapy is aimed at recognising and reflecting on your negative thoughts and supporting you to change your behaviour. The distress is not necessarily caused by the sound but by how we think about it. Yes, having tinnitus is an annoyance, and it is unpleasant. However, when these initial negative feelings are followed by even more negative thoughts such as “this will ruin my day, I won’t be able to sleep, I will be a wreck tomorrow”, it spirals us into a negative cycle of feeling more and more anxious and depressed, ruminating about catastrophic scenarios, and it goes on and on.

Therapy can address this process by helping you address your own negative thoughts to stop the escalation of difficult feelings. In CBT sessions, you can also learn to be less fearful of situations where tinnitus might interfere, and you can feel empowered to live your life as you wish instead of being controlled by your tinnitus.

It is not easy to live with tinnitus, and the journey of CBT therapy is also challenging. You might be asked to face your fears, stop avoiding situations where your tinnitus can get worse and reflect on how you feel and what your deep-seated worries are. However, the hope is that you come out stronger, you can see how resilient you can be and how much life is still out there for you to live, even if tinnitus accompanies you everywhere.