Tinnitus is a term used to refer to the awareness of sound when there is no external noise. It is sometimes referred to as 'ringing' in the ears but can take the form of a number of sounds such as ringing, buzzing, pulsing, whooshing, whistling and roaring.
Tinnitus is a disorder of the hearing system, not a disease. Tinnitus is relatively common, with some studies suggesting that up to 20 per cent of the Australian population has some form of tinnitus, ranging from mild to more severe. Less commonly, tinnitus can be symptomatic of another condition therefore it is important to consult a medical specialist if you are experiencing tinnitus. A thorough medical assessment will help identify and possibly remedy any conditions that are causing the tinnitus.
Tinnitus may also be experienced with hearing loss and once this hearing loss is rectifed, tinnitus can often become less problematic. Several sources are known to trigger or worsen tinnitus - in particular, exposure to loud noise. Exposure to loud noises such as heavy machinery, lawnmowers and loud music remains the most common preventable cause of tinnitus.
For the majority of people it is often not possible to identify a condition or a disease that is causing their tinnitus. This is because the tinnitus is likely caused by a dysfunction in their auditory system. The ears represent only part of the auditory system. Other parts of the brain are also involved in hearing, including parts of the brain responsible for memory and emotion. Many different parts of the brain work together to help us hear, understand and respond to a 'sound'. Understanding how the auditory system works helps us understand tinnitus and what can be done to manage it.
There is no universally accepted "cure" for tinnitus however there is a lot that can be done to help you manage your tinnitus. Although tinnitus is not a psychological problem, using psychological techniques can help reduce the distress you might be experiencing because of your tinnitus. A type of psychological therapy - known as Cognitive Behaviour Therapy (CBT) - has been particularly demonstrated to be effective in reducing both distress and the awareness of tinnitus in a significant number of patients. Other management techniques such as Sound therapy and Tinnitus Retraining Therapy (TRT) can also be helpful.
To read more about tinnitus, causes and therapies, please check out some of the suggested links on the 'Useful information' page of this website.
Disorders of Sound Intolerance: Hyperacusis, Misophonia & Phonophobia
The term 'hyperacusis' generally refers to an oversensitivity of hearing where ordinary everyday sounds become very difficult to tolerate. Sounds that most of us would regard as modest and unobtrusive are experienced as distressing, intrusive and even painful for the hyperacusis sufferer. There are other terms sometimes used to describe different types of sound sensitivity , including misophonia, phonophobia and recruitment. There are subtle differences between all these terms.
The prevalence of hyperacusis has not been thoroughly established but it is known that a number of patients who suffer from tinnitus often report hyperacusis and vice versa. The two conditions can also occur quite separately. As with tinnitus, there is no universally accepted 'cure' for hyperacusis. At Psychology and Health, management of hyperacusis usually involves elements of both Cognitive Behavioural Therapy (CBT) and Tinnitus Retraining Therapy (TRT). You can read more about these in the 'What do we do' section of this website.
Please visit the 'Useful Information' page of this website for some suggested hyperacusis resources.
'Recruitment' often occurs with hearing loss and is defined in the Dorlands Medical Dictionary as an "abnormally large increase in the perceived loudness of a sound caused by a slight increase in intensity" . Thus, a person suffering from recruitment might struggle to hear the TV at a particular volume but when the volume is turned up just slightly, will suddenly experience the TV volume as far too loud. An audiologist is best qualified to assist in the treament of recruitment.
'Misophonia' is subtly different to hyperacusis in that it is generally used to refer to an aversion, or negative reaction to particular trigger sounds. The literal translation of misophonia from its Greek origin is "hatred of sound". Misophonia is sometimes referred to as 'Selective Sound Sensitivity Syndrome' (4S).
Misophonia (or '4S') is not currently a recognised diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the ICD-10 (International Statistical Classification of Diseases and Related Health Problems). There are several online support groups/forums for sufferers of misophonia however the condition is relatively unexplored by researchers and there is not presently an established 'treatment'. Evidence indicates that sufferers usually share similar trigger sounds - typically, repetitive sounds like chewing, lip smacking, sniffling and pen clicking. These sounds tend to elicit reponses like anger, rage, disgust and anxiety as well as high levels of autonomic arousal (for example, tense muscles, sweating, increased heart rate). Less commonly, individuals may experience visual triggers. Sufferers tend to be triggered most by those adults to whom they are closest. Although research is limited it appears that the disorder typically onsets in late childhood/adolescence.
At Psychology and Health, Cognitive and Behavioural Therapy (CBT) techniques are used to help individuals manage the symptoms described above. Counselling focuses on helping individuals reduce the intensity of their physical and emotional response to a trigger sound. The roles of various contributing factors are addressed. For example, sufferers tend to hyperfocus on the noise, its source, and frequently scan their environment for trigger sounds. Examining how such behaviours may exacerbate symptoms and learning to control them is important. Education about how the brain processes sound, how emotions and other parts of the brain are involved is also a component of therapy. Understanding the auditory system aids in understanding misophonia and what might be done to manage it.
To read more about 'misophonia', please check out some of the suggested links on the 'Useful information' page of this website.
'Phonophobia' is a term more frequently in use and generally refers to an irrational fear of sounds. Often people with hyperacusis protect their hearing, fearful of exposing themselves to ordinary sounds due to their heightened sensitivity to these sounds. Phonophobia and hyperacusis are often confused in the literature and do share some similarities. Phonophobia however may be considered subtely different in that, whilst it is related to reduced sound tolerance, it seems to be an irrational fear of particular sound/s that is the issue. Cognitive and Behavioural Therapy (CBT) techniques are used at Psychology and Health to treat phonophobia.
Dr Anna Kittle, Clinical Psychologist in Sydney. CBT Treatment and therapy for tinnitus. Managing disorders associated with hearing and sound intolerance e.g hyperacusis, misophonia and phonophobia. There is presently no established 'misophonia' treatment . Cognitive and Behavioural Therapy (CBT) techniques can be used to help individuals manage these conditions.