Understanding Reactive Tinnitus

older man talking to his doctor about reactive tinnitus

Most people are familiar with tinnitus – that frustrating ringing in the ears that often comes and goes without provocation. What you may be less familiar with is a form of tinnitus that changes in loudness, quality, or pitch, in response to average or even low-level noises. This is called reactive tinnitus – and the resulting discomfort can be difficult to tolerate, and even painful.

What Is Reactive Tinnitus?

Reactive tinnitus, sometimes referred to as tinnitus-induced hyperacusis or sound-sensitive tinnitus, occurs from changes in the brain that affect the way neurons inhibit or increase activity in response to various stimuli. The condition is rare, since most forms of tinnitus don’t typically fluctuate or worsen based on external sounds. 

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For people with hyperacusis or hypersensitivity to average-level sounds, however, it may be a bit more common. In fact, it’s estimated that anywhere from 12-63% of people with tinnitus also have hyperacusis, and therefore may be more prone to reactive tinnitus. 

There are two important things to keep in mind if you struggle with reactive tinnitus. 

First, because reactive tinnitus is just that – a reaction to noise – there are therapies that can offer relief. Remember, the brain is an adaptive organ, so it has the capacity to “retrain” how to respond to any number of triggers.

And second, the condition can be both actually and metaphorically in your head. For most people with reactive tinnitus, the perception that their tinnitus is worsening because of more acute episodes can cause a flood of negative emotions and discomfort, thus compelling them to try to avoid sounds altogether. This strategy of avoidance, including the use of earplugs, usually intensifies the condition by reducing tolerance of everyday noises. Other sufferers may develop a kind of persistent anxiety for fear that routine, ambient sounds could trigger a reaction. 

Treatment Options

Like so many treatments for tinnitus, Cognitive Behavioral Therapy (CBT) techniques are a great place to start. 

Because most forms of tinnitus are exacerbated by stress, CBT strategies can help ease the triggers that lead to flare-ups. CBT is an evidence-based modality that gives people experiencing tinnitus tools to better control their anxiety. While CBT is not a cure, it offers coping techniques that help people adapt, live with, and ultimately tame stressors. CBT is especially useful because with reactive tinnitus, the brain reinforces to itself that the worst will happen when it’s exposed to tinnitus or triggering external sounds; this happens through multiple interactions which can involve stress hormones, such as cortisol. CBT helps reduce this reinforcement by restructuring thoughts around the tinnitus and triggering sounds, ultimately leading to reduced triggering events and stress reactions.

Another great form of intervention is sound therapy, which is usually initiated after or as part of CBT. The process uses pleasant noises to reduce or cushion the impact of triggering external sounds, and to help reduce the intrusiveness of tinnitus. Calming sounds can provide relief by redirecting attention away from tinnitus. Gradual exposure to these sounds over time help underscore to the brain that sounds are not dangerous to the ear or auditory system, and therefore reduce the brain’s reaction to various sounds. And as a bonus: sound therapy can be effective in managing hyperacusis and general tinnitus, as well. 

A Word Of Encouragement 

Like all forms of tinnitus and other hearing issues, it’s advisable to connect with your clinicians first to rule out any underlying medical conditions that may be part of your reactive tinnitus. From there, a clinician can be a key ally in referring you to the right professionals to support longer term therapies like counseling, meditation, or sound therapy. 

And although the progress may feel slow, rest assured that reactive tinnitus does respond to treatment. The sooner you start, the quicker your treatment journey begins. 

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