Imagine a sound that travels with you no matter where you go. Whether it's a ring, a whoosh or a crickets-like buzz, you can't escape it.
"Mine was like this high-pitched sonic sound," says Elizabeth Fraser, who developed tinnitus last fall. It came on suddenly at a time when many people delayed doctor visits due to the coronavirus pandemic. "It just felt like an invasion in my head, so I was really distressed," Fraser recalls.
Tinnitus is the perception of ringing when, in fact, no external sound is being produced. "You can equate it to a phantom sound," explains Sarah Sydlowski, a doctor of audiology at Cleveland Clinic.
The Centers for Disease Control and Prevention estimates that 20 million Americans have chronic tinnitus. And studies show the pandemic ushered in both new cases and a worsening of the condition among people who already had it.
The British Tinnitus Association reported a surge in the number of people accessing its services, including a 256% increase in the number of web chats amid the pandemic.
"There's a link between increased stress and tinnitus either initiating or worsening," says Eldre Beukes, an audiologist at Lamar University, so she wasn't surprised by the pandemic's effect. Her research shows that people with preexisting tinnitus who experienced loneliness, isolation or increased worries were most likely to report a worsening during the pandemic.
Tinnitus can occur anytime in a life span. "I have patients of all ages who report tinnitus from barely noticeable to incapacitating," Sydlowski says. She says there are instances when the ringing can be traumatic enough that it causes people to have thoughts of self-harm because it feels inescapable.
"A lot of people leave their doctor's office in a panic when they experience bothersome tinnitus," says Jennifer Gans, a psychologist who has pioneered research into treatment options. People are told there's no pill and no surgery that can cure it. But "there are many ways to manage tinnitus that people often aren't aware of," she adds.
Here are techniques to try and facts to know about the condition.
1. Try mindfulness and therapy to "retune the brain"
Tinnitus can make people angry and frustrated. They often feel as if they can't focus on anything other than the ringing, and the accompanying anxiety tends to amp up the sound. Mindfulness training gives people tools to replace the stress response with a relaxation response and through the process to become desensitized to the ring.
One place to start is by working with negative thoughts — the terrifying ideas that crop up, like "I can't live like this" or "Maybe I'm dying."
"With practice, we can retune the brain or retune these habitual thoughts," says Gans, who developed an online course called Mindfulness-Based Tinnitus Stress Reduction. It's based on research she did while she worked at the University of California, San Francisco.
"I Immediately felt better," says Fraser, who took the online course from Gans. "It pretty quickly takes you to the point of learning how to manage your anxiety and how to calm the nervous system."
The course is built on the foundation of Jon Kabat-Zinn's mindfulness program, which has been shown to help ease the burden of chronic pain. The goal is to help people bring awareness to the present moment, without fear or anxiety about the past or future. People who've taken the course say they've learned to live with greater acceptance.
This approach can help patients shift their focus away from the ringing, which may lead it to recede into the background. One mindfulness technique that helps with this is doing a body scan where you bring your attention to the sensations in each part of the body from head to toe. (Find a variety of body scan recordings at the University of California, San Diego's Center for Mindfulness, or listen to Kabat-Zinn's recording here.)
The American Tinnitus Association points to a range of additional behavioral therapies, from tinnitus retraining therapy to acceptance and commitment therapy, that teach similar strategies and have been shown to be effective in reducing tinnitus-related distress, anxiety and depression.
2. Mask the ringing
Sometimes getting the ringing to tune down is a simple as distracting yourself with other background noise, says Sydlowski of the Cleveland Clinic.
"Even something as simple as running a fan or putting a radio between stations at a low level at nighttime when someone's trying to sleep can be really helpful," she says.
The American Tinnitus Association points to a range of sound-masking devices that may help alter a person's perception of, or reaction to, the ringing. The organization says that like other tinnitus treatments, the devices don't cure the condition, but they may reduce "the perceived burden and intensity of tinnitus."
When Fraser is bothered by the ring, she uses a white noise app that plays the sound of gently falling rain. "That helps a lot," she says. It masks the ringing and creates a distraction.
Like many people with tinnitus, Fraser says her busiest days are her best days, since she tends to notice the ringing less when she's with others or engaged in an activity. A quiet evening or being home alone can be a challenge, since it creates more of an opportunity to focus on the ringing. So these are the times when she turns to the white noise.
3. Have your hearing checked
Injuries or exposure to loud noises can increase the risk of tinnitus. For instance, veterans with traumatic brain injuries are more likely to experience it. And many people develop tinnitus as the result of hearing loss, which is more common as people age.
One type of hearing loss involves damage to the tiny hairs in the cochlea that make it possible to hear certain frequencies. "With the loss of those hair cells, the brain starts to say, 'Wait a minute. I've always heard that frequency before. Where is it?' " Gans, the psychologist, explains. So as the brain starts to search and doesn't find it, the brain can get confused. "The [ringing in the ears] is a signal that the overexcitement of the neurons creates," Gans explains.
Some people with hearing loss who develop tinnitus notice improvements with hearing aids, Sydlowski says. For severe cases of tinnitus, she says, some patients have benefited from using a cochlear implant.
4. Check for related health problems
"Tinnitus itself is harmless," says Lamar University's Beukes, but it's linked to other health concerns beyond hearing loss. A clear catalyst is not always known, but the onset has been associated with many other conditions, such as TMJ or jaw issues.
"There's been an increase in individuals reporting jaw pain from clenching their teeth and having additional stress" amid the pandemic, says Sydlowski. So it's possible this could trigger the onset of tinnitus.
In addition, certain medications delivered at high doses are associated with the condition. Given the range of issues linked to tinnitus, it's prudent for people to see a health care provider at the onset of tinnitus, Sydlowski says.
"It could be the sign of something more serious that needs to be addressed, " she says. She advises people to see an audiologist or specialist in tinnitus management.
5. Watch your stress barometer
A healthy lifestyle, including daily movement and a good diet, does not have a direct impact on the biology of tinnitus, according to the American Tinnitus Association, but it may help people cope with it better.
Given the link between tinnitus and stress, Gans says it's important to keep an eye on related problems that can accompany the condition, such as trouble sleeping, anxiety and depression.
Stress can escalate slowly, and often, people may not be aware, so if they notice the ringing sound intensifying, Gans says, it can serve as a warning signal. "When the tinnitus becomes bothersome, it's a moment for you to say, 'Whoa, I need to push back and do some self-care,' " Gans says.
This is when it may be time to take a mental health day: Unplug from technology, take a walk, exercise or turn to a hobby that's relaxing.
Taking care of yourself in these ways is good for your overall health, and it may very well quiet the troubling noise.