Tinnitus habituation: Benefits & how it can treat tinnitus

Understanding tinnitus

If you’ve ever perceived a persistent, high-pitched ringing in your ears or head, you’ve experienced tinnitus firsthand. This phenomenon affects an estimated 25 million Americans each and every year, with varying degrees of prevalence. Some people experience tinnitus as a loud, persistent tone similar to the sound of cicadas or crickets, while others only hear ringing softly, and at seemingly random intervals.

Most cases are referred to as “subjective” tinnitus, because the person experiencing the ringing is the only one able to hear it. The exact mechanisms behind tinnitus remain somewhat of a mystery but many professionals think it’s brought on by a misfiring of auditory neurons related to noise exposure, hearing loss, earwax impaction, or an underlying condition such as an ear infection, head injury,  or temporomandibular joint disorder (TMJ).

While tinnitus itself is physically harmless, it can be an irritating experience that detracts from a person’s focus and overall quality of life. There’s not yet a permanent cure for tinnitus, but medical advancements have led to an abundance of treatment options that mask unwanted ringing to a point where it becomes barely noticeable. One such treatment method is referred to as tinnitus habituation.

Introduction to habituation

Habituation refers to the process of becoming so accustomed to a stimulus that it no longer captures your attention. It’s something most people experience in everyday life. For instance, if you live near a railway, the noise of passing trains may seem disruptive at first, but over time those once-startling sounds fade into the background and are barely noticed. Tinnitus habituation works in a similar way: with repeated exposure, the brain learns to filter out the perception of tinnitus so it no longer feels intrusive.

Differences between habituation and adaptation

Adaptation is similar to habituation in that both result in a reduced response, but they aren’t quite the same. The biggest difference between the two involves one’s awareness of desensitization. Sensory adaptation occurs involuntarily at a neuro-cellular level, while habituation refers to a conscious shift in perception that develops as the brain learns to tune out a stimulus over time.

A useful way to think about this is in the context of relationships. The more familiar we become with another person, the less our brains tend to be stimulated when they’re around— at the neural level, that’s sensory adaptation. But on a conscious level, the individual may also experience habituation, perceiving the relationship differently as familiarity deepens.

Tinnitus habituation: An overview

In the same way that a person can get used to hanging around the same person or hearing the same external sounds, it’s also possible to habituate oneself to tinnitus to the point where it’s barely noticeable. Habituation techniques are proven to effectively diminish negative reactions to tinnitus including stress, anxiety, and irritation. Over time, a decreased frequency of negative reactions teaches the brain to stop perceiving tinnitus as a threat, which translates to you noticing it less. This can be done with the help of medical professionals and equipment like hearing aids for tinnitus, or at home with the help of select therapies and relaxation techniques.

The timeframe for tinnitus habituation

Because the ultimate goal of tinnitus habituation is to create lasting changes within the brain, it can take some time for the necessary neural changes to take place. Most patients start noticing changes two to three months after beginning habituation treatment, but in some cases, it can take up to 18 months to successfully complete the process.

Techniques for tinnitus habituation

There are several different ways for a person to achieve tinnitus habituation. Many people incorporate multiple approaches into their treatment program, but we recommend trying out as many as you can to see what works best for you.

Sound therapy

Sound therapy involves the use of the following devices, any of which can be used to play external sounds that train the brian to tune out unwanted ringing or buzzing.

White noise machines — By default, most white noise machines produce a constant sound similar to static that offers effective tinnitus masking. White noise works by distributing sound evenly across all frequencies, creating a steady blanket of sound that can cover or “drown out” the ringing or buzzing of tinnitus. Using one in combination with pillow speakers can be especially helpful to people who suffer from loud bouts of nighttime tinnitus.

Pink noise — Unlike white noise, pink noise reduces intensity as frequency increases. This creates a deeper, more balanced sound profile that many people describe as gentler and more natural, similar to steady rainfall. A recent study suggests that pink noise combined with fractal tones (semi-repetitive, music-like patterns) may improve long-term comfort and adherence to sound therapy programs.

Nature sounds and environmental noise — Many white noise machines also offer pre-set nature sounds like “rainforest,” “waves,” and other ambient settings. These can be a soothing alternative to traditional white noise, which some people find too grating for sleep. The relaxing nature of these sounds offers the added benefit of stress and anxiety relief.

Hearing aids and maskers — Most people who wear hearing aids for tinnitus report significant relief from unwanted symptoms. Hearing aids amplify missing frequencies in the wearer’s environment to compensate for their hearing loss, and this amplification is sometimes loud enough to block out tinnitus ringing on its own. Today, many hearing aids are also equipped with designated tinnitus relief programs that can be customized to mask the exact frequency of a person’s tinnitus.

Cognitive behavioral therapy (CBT)

In cases where masking and amplification aren’t enough, patients may consider working with a behavioral therapist to achieve habituation through cognitive behavioral therapy, or CBT. This approach doesn’t necessarily make tinnitus quieter, but instead focuses on helping the patient change the attitudes and behaviors around their tinnitus.

During sessions, patients work with the therapist to identify problematic patterns that arise from their negative feelings. From there, you can develop definitive strategies to replace harmful behaviors — such as turning on the TV when tinnitus is keeping you up, and subsequently staying up for several hours — with positive coping mechanisms that slowly shift your attention away from the symptoms.

The specifics of CBT look different for every patient, but most can expect treatment to last three to 22 weeks, either individually or in a small group. Keep in mind that research shows CBT doesn’t lower tinnitus loudness but reliably reduces the distress it causes, making it one of the most effective non-sound-based therapies.

Mindfulness and relaxation techniques

While this area of tinnitus treatment is newer than others, contemporary studies have found that patients who practice mindfulness techniques report significantly less distress from their tinnitus than those who don’t. Common practices in this field include:

Meditation practices — Believe it or not, there are several different ways to meditate. Mindfulness meditation invites practitioners to simply be mindful of the present movement, while movement meditation is accompanied by gentle exercises like yoga, tai chi, and walking. People with tinnitus may have a hard time keeping their focus in total silence due to persistent ringing, buzzing, or clicking  — but you can always pair your meditation sessions with gentle background music or white noise for added support.

Breathing exercises — Intentional breathing moderation can work wonders to alleviate anxiety of any kind, including anxiety related to tinnitus. One popular method, known as “box breathing,” consists of inhaling through the nose for four counts, pausing for four counts, exhaling through the nose for four counts, then pausing for four counts. Repeat this process as needed until your stress begins to settle, and try out different breathing techniques for anxiety if this one doesn’t feel right for you.

Progressive muscle relaxation — This practice involves tensing different muscle groups for five to ten-second intervals before gradually releasing the tension to alleviate stress levels.  Inhale before you tense the muscles, and slowly exhale as you allow the tension to flow out of your body. Start with your toes and work your way up, and make sure to take a 10-second pause before moving on to the next group.

Lifestyle modifications

Diet and nutrition for tinnitus — There’s no strong evidence that eating certain foods either improves or worsens tinnitus symptoms, but eating a healthy diet undeniably offers a host of mental and physical health benefits, including improved circulation, weight loss, a boost in energy levels, and improved mood. Collectively, these benefits may offer some degree of tinnitus relief.

The one exception to this rule is caffeine. Limited evidence suggests high intake may result in more intense tinnitus symptoms  — but this could also be tied to other factors such as age.

Managing stress and anxiety — There’s no evidence to suggest that stress causes tinnitus, but most people who suffer from moderate to severe tinnitus symptoms tend to experience anxiety and frustration as a result of their symptoms. Mindfulness and relaxation practices are healthy, effective ways to mitigate tinnitus-related stress, as are counseling sessions in the form of individual or group therapy.

Regular exercise and physical activity — On top of promoting physical well-being, regular exercise is a great way to minimize the emotional distress related to tinnitus and boost your overall mental health. It’s not uncommon, however, for some people to notice temporary ear ringing after workouts. This can be triggered by factors like blood pressure changes, dehydration, muscle tension, or even loud gym environments. Staying hydrated, avoiding breath-holding during heavy lifts, and protecting your ears from loud music can help reduce these effects. In most cases the ringing fades quickly, but if it persists, it’s best to consult an audiologist.

Professional support for tinnitus habituation

While most tinnitus retraining techniques can be practiced on your own, many patients find the process of habituation more effective when it’s accompanied by the support by their peers and professional hearing care specialists. Consider reaching out to these groups if you’d prefer professional assistance on your tinnitus treatment journey:

Audiologists and hearing specialists

In the majority of cases, tinnitus is directly tied to a person’s hearing health. Audiologists and other licensed hearing care specialists can give you a detailed breakdown of all the treatment options that might benefit your particular case. An audiologist can also fit you with a prescription hearing aid customized to mask the exact frequency of your tinnitus.

Psychologists and therapists

The psychological effects of tinnitus don’t get nearly as much attention as they should. The truth is that tinnitus can be a deeply debilitating condition that brings with it a host of negative emotions, including anger, anxiety, depression, and insecurity. Many people who suffer from tinnitus report periods of social isolation due to hearing issues and sensitivities that lead to a decline in conversational skills. In cases like these, a mental health specialist like a therapist can make a great resource to help you reframe negative thought patterns and replace them with effective coping skills.

Support groups and online communities

Online and in-person support groups are great places to find communities of peers who understand what you’re going through at a core level. These groups give tinnitus patients outlets to share their struggles and engage with each other in a supportive, judgment free space. If you’re interested in attending, the American Tinnitus Association keeps a calendar of tinnitus support group meetings all around the country.

Measuring Progress in Tinnitus Habituation

Because tinnitus is largely a subjective experience, there’s no precise way to gauge where you’re at in your habituation journey. These tools and techniques can help you keep track of your physical and emotional symptoms over time, and subsequently give you a better idea of your treatment progress.

Tracking symptoms and relief — You may find it helpful to keep a journal containing your daily symptoms, including the severity of tinnitus and your emotional response to it. In early stages of habituation, patients can usually hear their tinnitus, but no longer experience severe emotional distress as a result. Later, as your exposure to the same stimulus increases, the brain will start to tune out tinnitus ringing more often than not, even though the sound is still there.

Self-assessment tools — Other useful monitoring tools include the Tinnitus Functional Index, a 25-question survey patients can fill out to assess the severity of their symptoms, and visual analog scales, which can be used to provide a helpful visual representation of tinnitus severity. Use these in tandem when undergoing habituation treatment to measure how your responses change over time.

Professional assessments — Ear, nose, and throat specialists, also known as ENTs, rely on procedures including ​​the Tinnitus Handicap Index (THI), tinnitus pitch matching, tinnitus loudness matching, and tinnitus masking tests to track the severity of a patient’s symptoms and develop corresponding masking levels. A specialist can also offer counseling to help patients better understand the mechanisms behind the changes in their condition as they progress further into habituation treatment.

Challenges and considerations

It’s important to remember that habituation is not a cure for tinnitus. The sound of your tinnitus may not ever go away completely, but your emotional response to it will be altered in such a way that the ringing sound no longer leads to negative thoughts and emotions. Even then, you may still find some days are harder to manage than others. Dealing with unforeseen obstacles is never fun, but educating yourself on them before they pop up is a great way to make the habituation process easier to manage.

Factors that may impede habituation

Daily factors including stress levels and quality of sleep can significantly alter a person’s mood, which in turn can make their tinnitus seem more intense. Environmental factors, such as exposure to loud noises or prolonged periods in a quiet setting, may also exacerbate the intensity of symptoms. The same goes for underlying health problems, including sinus congestion, ear infection, and fluctuations in blood pressure. You can limit your exposure to these triggers by maintaining a healthy lifestyle and practicing some of the stress management techniques outlined above.

Coping with setbacks and flare-ups

Habituation is a gradual process that’s not always linear. Most patients find that after enough time has passed, unexpected circumstances arise that make their tinnitus change or spike. If these circumstances don’t resolve quickly, many will find themselves getting bothered by the sounds all over again.

When setbacks and relapses inevitably occur, it can be hard to stay hopeful that your condition will ever truly improve. These periods can even be more intense than tinnitus bouts before habituation treatment, because suddenly, it feels like all your hard-earned progress has been stripped away.

You can minimize the intensity of relapses by doubling down on the coping mechanisms that served you best during your habituation treatment. It may even help to keep a written list of the tools and techniques that give you the most tinnitus relief, so you immediately have a plan in place when doubt starts to creep in. The more often you implement these methods to keep yourself from throwing your hands up, the more trust you will inherently start to build with the habituation process.

Individual variability in habituation

The length of time needed to achieve habituation will be different for everyone, with a unique set of ebbs and flows along the way. Depending on the underlying cause of your tinnitus, you may find that certain tools or techniques provide significant relief very quickly, or not at all.

There’s no “one size fits all” solution for a condition like tinnitus, but that doesn’t mean you have to be miserable while you’re figuring out what does and doesn’t work for you. Show yourself plenty of patience as you slowly habituate to unwanted sounds. Even if it doesn’t feel like it’s getting better right now, it’s important to remember that it will get better eventually. Studies show that roughly three-quarters of tinnitus sufferers will naturally habituate to their condition over time, without the help of any external tools or treatment protocols.

Future directions in tinnitus treatment

Scientists are constantly coming up with new ways to treat tinnitus. Recent studies have linked the cause of subjective tinnitus to underlying cochlear damage, which may be alleviated with the help of surgically implanted hearing prosthetics known as cochlear implants. While the data behind these studies is too broad to be considered conclusive, an estimated 34% to 92% of implant recipients have noted improvement or total resolution of their tinnitus symptoms.

Most recently, genes and metabolic factors have been linked to the incidence of tinnitus. In the near future, these may lead to new diagnostic procedures and alternatives to traditional tinnitus therapies. Mixed evidence suggests that herbal compounds including acai, Red Asian ginseng, and gingko biloba may also reduce the severity of tinnitus when consumed on a daily basis.

Conclusion

Even after habituation is complete, there will still be times when you catch yourself noticing your tinnitus (especially in quiet settings). It may not be an immediate, permanent fix, but tinnitus habituation can bring you lasting relief from tinnitus symptoms as long as you stick with the treatment and trust the process through the ups and downs.

Further info on tinnitus treatment and support groups can be found through national organizations including the American Speech-Language Hearing Association (ASHA) and the American Tinnitus Association.